Paradox of hepatitis B: Metabolic risk and cardiovascular protection in a national cohort

Background: Although Hepatitis B virus (HBV) is primarily associated with hepatic complications, its link to systemic metabolic and cardiovascular diseases remains inconclusive. This study investigated the paradoxical relationship between HBV infection and cardiovascular outcomes in a large nationwide cohort. Methods: A retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database (2010-2020). After strict exclusion and two-step propensity score matching, 409,799 HBV-infected patients and 2,048,995 matched controls were identified. We analyzed the incidence of metabolic disorders, major adverse cardiovascular events (MACE), and all-cause mortality. Results: HBV infection was associated with increased risks of diabetes (HR: 1.10), hypertension (HR: 1.17), and hyperlipidemia (HR: 1.18). Paradoxically, HBV patients exhibited significantly lower risks of coronary artery disease (HR: 0.88), acute myocardial infarction (HR: 0.61), ischemic stroke (HR: 0.70), and cardiovascular death (HR: 0.58). Despite this cardiovascular protection, all-cause mortality was markedly higher in the HBV group (HR: 2.31). Conclusions: Chronic HBV infection presents a distinct clinical paradox: increased metabolic risk but reduced cardiovascular events. These findings suggest complex immune-metabolic interactions. Clinical management should address both the hepatic burden and the elevated metabolic risks, despite the apparent cardiovascular protection.