Hepatitis B virus (HBV) infection has been linked to systemic effects beyond the liver, but its relationship with specific cardiovascular outcomes remains uncertain. This nationwide prospective cohort study published in the Journal of Viral Hepatitis included 477,126 adults without a prior history of cardiovascular disease (CVD), recruited from 10 geographically diverse regions in China between 2004 and 2008. Participants were followed through December 31, 2016, with a mean follow-up of 9.94 years. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) for incident cardiovascular outcomes according to hepatitis B surface antigen (HBsAg) status. Subgroup analyses assessed potential effect modifiers.

During follow-up, 32,841 ischemic heart disease (IHD) events, 35,532 ischemic strokes, 5,538 intracerebral hemorrhages, 3,165 acute myocardial infarctions, and 2,939 heart failure events were recorded. Compared with HBsAg-negative participants, those who were HBsAg-positive had a lower risk of ischemic heart disease (HR 0.91; 95% CI 0.84–0.98; p=0.011) and a higher risk of intracerebral hemorrhage (HR 1.25; 95% CI 1.07–1.46; p=0.004). No significant associations were observed for ischemic stroke, acute myocardial infarction, or heart failure in the overall population.

The observed associations were consistent across subgroups defined by age, sex, study area, body mass index, alcohol intake, smoking status, and physical activity, and remained robust in sensitivity analyses.

In this large Chinese cohort, HBsAg positivity was associated with lower ischemic heart disease risk and higher intracerebral hemorrhage risk.