Associations of human papillomavirus infection (HPV) with cardiovascular health (CVH): Findings from the National Health and Nutrition Examination Survey (NHANES)

Abstract

Purpose: Evidence has shown a possible association between human papillomavirus (HPV), a sexually transmitted disease, and increased risk of cardiovascular disease (CVD). These longitudinal studies, however, are limited to women in South Korea. It is unclear if adults with HPV have worse cardiovascular health (CVH) that may put them at risk of CVD. We examined the associations between HPV infection and poor CVH among the 2016-2018 National Health and Nutrition Examination Survey (NHANES), an US-based survey of Americans.

Methods: During NHANES, adults aged 18-59 years old gave a genital or oral biospecimen that was genotyped for HPV. We included 2,151 participants with an oral sample and 1,655 with a genital sample. CVH was measured using the American Heart Association’s Life Essential 8 (LE8). This metric includes health factors associated with CVH, including diet, physical activity, nicotine use, sleep, body mass index (BMI), blood lipids, blood glucose, and blood pressure. A CVH score was calculated using the mean across the 8 items and ranged from 0-100. CVH scores <50 were classified as poor CVH. We examined the association between HPV infection and poor CVH with frequencies, means, odds ratios (OR) and 95% confidence intervals (95% CI). We used complex survey weights to account for the NHANES study design.

Results: Among participants with an oral sample, the average age was 44 years, 51% were female, 65.8% were non-Hispanic white, and 31.8% had at least a college education. Demographics were similar among participants in the genital sample. The prevalence of HPV was 6.3% and 40.1% in the oral and genital samples, respectively. The average LE8 score was 65.4 and 66.2 in the oral and genital samples, respectively. Participants who tested positive for HPV had lower LE8 scores than those without HPV. Among the oral sample, those with HPV had an average score of 61.7 (95% CI 58.4, 65.1) compared to 65.8 among those without HPV. Among the genital sample, those with HPV had an average of 62.4 (95% CI 59.6, 65.1) compared to 68.8 for those without HPV. For each LE8 component, the average was similar for those with and without HPV except for smoking. Participants with HPV had an average smoking score of 42.5 compared to 60.4 for those without HPV among the oral sample. Among the genital sample, those with HPV had an average smoking score of 46.5 compared to 65.2. Among the oral site, participants with HPV had 1.38 (95% CI 0.68, 2.81) times the odds of poor CVH compared to those without HPV. Among the genital site, participants with HPV had 2.06 (95% CI 1.45, 2.88) times the odds of poor CVH compared to those without HPV.

Conclusions: Participants with HPV had worse CVH than those without HPV, with the association stronger among participants in the genital sample. The poor CVH among those with HPV may be due to differences in smoking behavior.