Are HPV infection and CVD risk linked?

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The link between certain strains of human papillomavirus (HPV) and cervical cancer is well known. Now researchers have examined whether the virus is also linked with increased risk of cardiovascular disease (CVD).

Results of a new study, by researchers from Korea, appear in Circulation Research.

The Kangbuk Samsung Health Study was a cohort study involving Korean women aged 30 years or older who underwent standard Pap screening with DNA testing for 13 strains of high-risk HPV as part of an annual comprehensive health exam. Information on the participants’ cholesterol and glucose levels also were gathered with blood tests and they filled out questionnaires about demographic information, such as smoking status, body mass index (BMI), education level, physical activity, and medical and family history. 

The primary outcome of the study was incident CVD, defined as first diagnosis of CVD identified through linkage to the Health Insurance Review and Assessment (HIRA) Service database by the end of 2016. 

More than 63,411 women who did not have CVD, with an average age of 39.7 years and average BMI of 21.8, were included in the study. Slightly more than 7% of the participants had high-risk HPV. During more than 261,000 person-years of follow-up, the authors identified 1,122 cases of new-onset CVD. The age-adjusted hazard ratio (HR) comparing high-risk HPV-positive to HPV-negative participants was 1.26 (95%: CI 1.03-1.49). 

When adjusting for BMI, year of screening exam, smoking status, alcohol intake, regular exercise, education level, family history of CVD and Charlson comorbidity index (CCI), the HR for incident CVD for high-risk HPV-positive versus HPV-negative participants was 1.22 (95% CI: 1.01-1.49). The association between high-risk HPV and incident CVD was stronger in obese women (BMI ≥ 25 kg/m²) than those who were not obese. 

During sensitivity analysis (where incident CVD was defined as the first hospital admission with a principal diagnosis of CVD), the multivariable-adjusted HR for high-risk HPV-positive versus high-risk HPV-negative participants was 1.07 (95% CI: 0.84-1.36) in the non-obese and 1.83 (95% CI: 1.24-2.69) in the obese women. 

While results of the study suggest that high-risk HPV is associated with increased CVD risk, the authors acknowledged that the research had limitations. Among those mentioned were defining a positive HPV infection as positive at baseline so spontaneous regression or incident cases during the follow-up period were not incorporated into the analysis. Data on specific HPV genotype, low-risk HPV infection or cervical pathology and information on the vaccination status of participants were both unavailable.