Table 3.
Summary of referenced studies and their limitations.
| Study | Study Design | Sample Size | Exposure | Outcomes | Results | Limitation(s) | Addressing limitations in this study |
| Pothineni, N et al. (2014) doi: 10.1016/j.amjcard.2014.09.020 | Retrospective cohort (2001–2013) | n = 24,484HCV Ab+: 8251HCV RNA+: 1434Controls: 14,799 | HCV infection (ICD-9) | Chronic stable angina, unstable angina, CAD, acute MI | HCV seropositivity (OR 1.32, 95% CI 1.09–1.60, p < 0.001)HCV RNA positivity (OR 1.59, 95% CI 1.13–2.26, p < 0.001) | Not adjusted for smoking statusNot adjusted for family history of vascular disease | Adjusted for smoking status; found to have increased odds of hospitalization for ACS eventAdjusted for family history of coronary heart disease as was a covariate of interest |
| Forde KA et al. (2012)doi: 10.1111/j.1365–2893.2011.01545.x | Retrospective cohort (1996–2008) | n = 76,477HCV+: 4809Controls: 71,668 | HCV infection (Read diagnostic code scheme) | Primary: first diagnosis of MI from start of follow-upSecondary: compositeoutcome of either incident MI or revascularizationprocedure | No difference in MI incidence rates between HCV+ vs HCV- (1.02 vs 0.92 events per 1000 person-years; p = 0.7)HCV infection was not associated with an increase risk of incident MI (adjusted HR 1.10; 95% CI 0.67–1.83) | Lacks data regarding patient race/ethnicityRelies on diagnostic codes and/or free text mention of HCV, no data regarding HCV Ab+ or RNA+ | Included race/ethnicity data in case matching to controlsDetermined presence of HCV infection via ICD-10 codes, Ab+, and RNA+ |
| Younossi ZM et al. (2013) doi: 10.1111/ apt.12234 | Retrospective cohort(1999–2010) | n = 19,741HCV RNA+: 173Controls: 19,568 | HCV infection (NHANES database) | IHD, stroke, CHF | Chronic hepatitis C infection independently associated with CHF (OR 2.49, 95% CI 1.04–5.96) but not IHD (OR 0.53, 95% CI 0.20–1.40) or stroke (OR 0.58, 95% CI 0.16–2.02)No overall association with CVD OR (0.93 95% CI 0.47–1.81) | Relied on self-reported cardiovascular outcomesMajority of patients <65 years old and relatively healthy | Cardiovascular outcomes determined from EMR with diagnosis being made by cardiology and internal medical inpatient teams likely more reliable than self-reportingWider age range, includes many more patients ≥65 years old |
| Williams-Nguyen J, et al. (2019) doi: 10.1093/aje/ kwz236 | Retrospective cohort (1998–2016) | n = 23,407HCV RNA+: 2,280Controls: 21,127 | HCV infection in those with HIV (ICD-9) | Type 1 and Type 2 MI | HCV was associated with a 46% greater risk of Type 2 MI (adjusted HR 1.46, 95% CI 1.09–1.97) but not Type 1 MI (adjusted HR 0.87, 95% CI 0.58–1.29) | Included HCV RNA only performed in course of routine clinical care, missing cases of chronic HCV | Determined presence of HCV infection via ICD-10 codes, Ab+, and RNA+ |