Study links high-risk HPV infection to increased heart-related deaths

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A study that tracked more than 160,000 Korean women for up to 17 years finds that those infected with a high-risk strain of human papillomavirus (HPV) were four times more likely to die of cardiovascular disease (CVD) than uninfected women.

High-risk HPV (HR-HPV) strains, a common transmitted sexually, are a well-known risk factor for cervical cancer.

For the study, published today in the European Heart Journal, researchers from Sungkyunkwan University School of Medicine in Seoul monitored 163,250 CVD-free women aged 30 years and older who underwent routine high-risk HR-HPV screening in 2004 to 2018. Average patient age was 40.2 years, 9.2% were infected with HR-HPV, all had few conventional CVD risk factors, and participants returned for healthcare visits every 1 or 2 years for a median of 8.6 years, until 2020.

"Understanding the contribution of HR-HPV infection to long-term cardiovascular consequences in women with HPV may have important clinical significance, particularly considering the availability of HPV vaccines," the study authors wrote.

Risk especially high in obese women

During 1.4 million person-years of follow-up, 134 women died of CVD, 16% of them HR-HPV–positive, for a death rate of 9.1 per 105 person-years for HR-HPV–negative women and 14.9 per 105 person-years for HR-HPV–positive women.

After adjustment for CVD risk factors and potential confounding factors, the risks of atherosclerotic CVD (ASCVD), ischemic heart disease, and death from stroke among infected women were 3.91, 3.74, and 5.86 times that of their uninfected peers.

We know that inflammation plays a pivotal role in the development and progression of cardiovascular disease, and viral infections are potential triggers of inflammation.

Hae Suk Cheong, MD, PhD, MPH

The link between HR-HPV infection and death from ASCVD was stronger in obese women than in those of a healthy weight, with HRs of 4.81 and 2.86, respectively.

"We know that inflammation plays a pivotal role in the development and progression of cardiovascular disease, and viral infections are potential triggers of inflammation," lead author Hae Suk Cheong, MD, PhD, MPH, said in a European Society of Cardiology press release. "It could be that the virus is creating inflammation in the blood vessels, contributing to blocked and damaged arteries and increasing the risk of cardiovascular disease."

He added that healthcare providers should monitor cardiovascular health in patients infected with HR-HPV, especially if they have risk factors such as obesity: "It's important for people with high-risk HPV to be aware of the potential for both heart disease and cervical cancer risks. They should engage in regular health screenings and adopt a healthy lifestyle to mitigate their risk of cardiovascular disease."

Increased vaccination may lower risk

The study authors called for research on whether HR-HPV infection also puts men at higher risk for CVD. "If these findings are confirmed, they could have substantial implications for public health strategies," senior author Seungho Ryu, MD, said in the release. "Increasing HPV vaccination rates may be an important strategy in reducing long-term cardiovascular risks."

In a related commentary, Noel Chan, MBBS, of McMaster University in Ontario, Canada, and colleagues said that, despite advances in screening for conventional CVD risk factors and treatment, ASCVD is still a leading cause of illness and death around the world. "Consequently, it is probable that there are other causal risk factors that are yet to be discovered or accepted by mainstream medicine," they wrote.

The study's results, together with other evidence of a link between viruses such as HPV and higher CVD death rates, "make a strong case for accepting viruses as risk factors for adverse outcomes from ASCVD," they concluded.