Impact of direct acting antivirals (DAAs) on cardiovascular events in HCV cohort with pre-diabetes

Ferdinando Carlo Sasso, Pia Clara Pafundi, Alfredo Caturano, Raffaele Galiero, Erica Vetrano, Riccardo Nevola, Salvatore Petta, Anna Ludovica Fracanzani, Carmine Coppola, Vito Di Marco, Antonio Solano, Rosa Lombardi, Mauro Giordano, Antonio Craxi, Alessandro Perrella, Celestino Sardu, Raffaele Marfella, Teresa Salvatore, Luigi Elio Adinolfi, Luca Rinaldi

Research output: Contribution to journalArticlepeer-review


Background and aims: Beyond type 2 diabetes, even a condition of prediabetes is associated with an increased cardiovascular (CV) risk, and HCV infection coexistence represents an exacerbating factor. CV prognosis improvement in prediabetes represents a challenge, due to the increasing prevalence of this metabolic condition worldwide. Hence, we aimed to prospectively assess how direct acting antivirals (DAAs) could affect major cardiovascular events (MACE) in a prediabetic HCV positive cohort. Methods and results: In this prospective multicenter study, we enrolled HCV patients with overt prediabetes. We compared a subgroup of patients treated with DAAs with untreated prediabetic controls. We recorded all CV events occurred during an overall median follow-up of 24 months (IQR 19–34). 770 HCV positive prediabetic patients were enrolled, 398 untreated controls and 372 DAAs treated patients. Overall, the CV events annual incidence was much higher among prediabetic treated patients (1.77 vs. 0.62, p < 0.001), and HCV clearance demonstrated to significantly reduce CV events (RR: 0.411, 95%CI 0.148–1.143; p < 0.001), with an estimated NNT for one additional patient to benefit of 52.1. Moreover, an independent association between a lower rate of CV events and HCV clearance after DAAs was observed (OR 4.67; 95%CI 0.44–53.95; p = 0.016). Conclusions: HCV eradication by DAAs allows a significant reduction of MACEs in the prediabetic population, and therefore represents a primary objective, regardless of the severity of liver disease and CV risk factors.

Original languageEnglish
JournalNutrition, Metabolism and Cardiovascular Diseases
Publication statusAccepted/In press - 2021


  • Cardiovascular risk
  • Direct acting antivirals
  • Hepatitis C virus
  • Prediabetes

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Endocrinology, Diabetes and Metabolism
  • Nutrition and Dietetics
  • Cardiology and Cardiovascular Medicine

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