This Article Full Text Full Text (PDF) All Versions of this Article: 38/5/1436    most recent STROKEAHA.106.466268v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sung, J. Articles by Davey Smith, G. Search for Related Content PubMed PubMed Citation Articles by Sung, J. Articles by Davey Smith, G. Pubmed/NCBI databases Medline Plus Health Information Heart Attack Hepatitis B Stroke Related Collections Acute myocardial infarction Epidemiology Risk Factors Acute Cerebral Hemorrhage Acute Cerebral Infarction

(Stroke. 2007;38:1436.)
© 2007 American Heart Association, Inc.

Original Contributions

Hepatitis B Virus Seropositivity and the Risk of Stroke and Myocardial Infarction

Joohon Sung, MD, MPH, PhD; Yun-Mi Song, MD, MPH, PhD; Yoon-Ho Choi, MD, PhD; Shah Ebrahim, DM, FRCP George Davey Smith, DSc, FMedSci

From the Department of Preventive Medicine (J.S.), Kangwon National University College of Medicine, Chunchon, Korea; the Department of Family Medicine (Y.-M.S.) and Center for Health Promotion (Y.-H.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; the Department of Epidemiology and Population Health (S.E.), London School of Hygiene and Tropical Medicine, London, England; and the Department of Social Medicine (G.D.S.), University of Bristol, Bristol, England.

Correspondence to Yun-Mi Song, MD, MPH, PhD, Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwondong, Gangnamgu, Seoul, South Korea. E-mail ymsong{at}smc.samsung.co.kr

Background and Purpose— Conflicting findings on the possible association between hepatitis B virus surface antigen (HBsAg) seropositivity and atherosclerosis have been reported. We examined the association between HBsAg seropositivity and cardiovascular diseases in a cohort of Koreans with a high prevalence of hepatitis B viral infection.

Methods— Men (N=521 421) aged 30 to 64 years were categorized into 4 groups according to HBsAg seropositivity status and the presence of liver dysfunction were followed up from 1990 to 2001 for both fatal and nonfatal myocardial infarctions (MIs) and strokes. The associations of HBsAg seropositivity with these cardiovascular diseases were examined with a Cox proportional-hazards model.

Result— Overall, HBsAg seropositivity was associated with a decreased risk of ischemic stroke and MI and an increased risk of hemorrhagic stroke, with multivariable-adjusted hazard ratios (95% CIs) of 0.79 (0.68, 0.90), 0.74 (0.62, 0.87), and 1.33 (1.15, 1.52), respectively. Risks for stroke and MI were similar between HBsAg-seronegative and HBsAg-seropositive men in the absence of liver dysfunction, whereas men with both HBsAg seropositivity and liver dysfunction had a higher risk of hemorrhagic stroke and lower risks of ischemic stroke and MI compared with HBsAg-seronegative men.

Conclusions— The association between HBsAg seropositivity and stroke and MI appears to be secondary to the liver dysfunction associated with hepatitis B viral infection. HBsAg seropositivity itself did not appear to play an important role in atherothrombosis through inducing a proinflammatory effect.

Key Words: cerebral hemorrhage • cerebral infarction • hepatitis B surface antigens • infection • myocardial infarction