Hepatitis B Virus Infection and the Risk of Cardiovascular Disease: Findings From the China Kadoorie Biobank.

The existing evidence on the association of hepatitis B virus (HBV) infection with the risk of cardiovascular disease (CVD) is limited and mixed. Moreover, no epidemiological studies have been conducted to comprehensively investigate this association in China. Hence, we performed a nationwide prospective cohort study to address these issues. Our study included 477,126 adults without a history of CVD. Participants were recruited from 10 diverse areas in China during 2004-2008, and followed up through December 31, 2016. Adjusted hazard ratio (HR) for CVD incidence was calculated using Cox regression. Subgroup analyses were conducted to identify the potential effect modifiers. During a mean follow-up of 9.94 years, 32,841 ischemic heart disease events, 35,532 ischemic strokes, 5538 intracerebral haemorrhages, 3165 acute myocardial infarction events, and 2939 heart failure events were observed. HBsAg-positive participants had a lower risk of ischemic heart disease [HR: 0.91, 95% confidence interval (CI): 0.84, 0.98; p: 0.011] but a higher risk of intracerebral haemorrhage (HR: 1.25, 95% CI: 1.07, 1.46; p: 0.004) than HBsAg-negative participants. These associations could not be modified by age, sex, study area, body mass index, regular alcohol intake, regular smoking, and physical activity level, and remained in a series of sensitivity analyses. No significant associations were found for ischemic stroke, acute myocardial infarction, and heart failure in the whole study population. In conclusion, HBV infection confers a decreased risk of ischemic heart disease but an increased risk of intracerebral haemorrhage in this Chinese population. More studies are needed to clarify the corresponding mechanisms.