Background/Aims Tenofovir disoproxil fumarate (TDF) is known to have a lipid-lowering effect. This is in contrast to tenofovir alafenamide (TAF), which has a lipid-neutral effect. Therefore, concerns have been raised as to whether these differences affect long-term cardiovascular risk. Here, we aimed to evaluate the long-term risk of cardiovascular events in chronic hepatitis B (CHB) patients treated with TAF or TDF. Methods We retrospectively analyzed 4,124 treatment-naïve CHB patients treated with TDF (n=3,186) or TAF (n=938) between 2012 and 2022. The primary outcome was a composite endpoint of major cardiovascular adverse events (MACE), including myocardial infarction, ischemic stroke, and hospitalization for unstable angina or heart failure. Serial changes in lipid profiles between two treatments were also explored. Results The median age of the patients was 50.6 years, and 60.6% of the patients were male. At baseline, 486(11.8%) and 637(15.4%) of the patients had dyslipidemia and fatty liver, respectively. A total of 42 MACEs occurred, with an annual incidence of 0.2%/100 person-years (PYs). At 1, 3, and 5 years, the cumulative risk of MACE was 0.4%, 0.8%, and 1.2% in patients treated with TDF, and 0.2%, 0.7%, and 0.7% in patients treated with TAF, respectively (p=0.538). No significant differences in the risk of MACE were observed between TDF and TAF. A multivariable analysis found that current smoker and a history of cardiovascular events were factors associated with an increased risk of MACE. Conclusions Patients treated with TAF had comparable risks of cardiovascular outcomes, defined as MACE, as patients treated with TDF.

中文翻译：

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使用富马酸替诺福韦二吡呋酯或替诺福韦艾拉酚胺治疗的慢性乙型肝炎患者的心血管风险。

背景/目标 富马酸替诺福韦二吡呋酯 (TDF) 已知具有降脂作用。这与替诺福韦艾拉酚胺 (TAF) 形成鲜明对比，后者具有脂质中性作用。因此，人们担心这些差异是否会影响长期心血管风险。在这里，我们的目的是评估接受 TAF 或 TDF 治疗的慢性乙型肝炎 (CHB) 患者发生心血管事件的长期风险。方法 我们回顾性分析了 2012 年至 2022 年期间接受 TDF (n=3,186) 或 TAF (n=938) 治疗的 4,124 名初治 CHB 患者。主要结局是主要心血管不良事件 (MACE) 的复合终点，包括心肌梗死、缺血性中风，以及因不稳定心绞痛或心力衰竭住院。还探讨了两种治疗之间血脂谱的连续变化。结果患者中位年龄50.6岁，其中男性占60.6%。基线时，分别有 486 名（11.8%）和 637 名（15.4%）患者患有血脂异常和脂肪肝。总共发生 42 起 MACE，年发生率为 0.2%/100 人年 (PY)。在 1 年、3 年和 5 年时，接受 TDF 治疗的患者的 MACE 累积风险分别为 0.4%、0.8% 和 1.2%，接受 TAF 治疗的患者则分别为 0.2%、0.7% 和 0.7%（p= 0.538）。TDF 和 TAF 之间的 MACE 风险没有显着差异。多变量分析发现，当前吸烟者和心血管事件史是与 MACE 风险增加相关的因素。结论 使用 TAF 治疗的患者与使用 TDF 治疗的患者具有相似的心血管结局（定义为 MACE）的风险。