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Chronic HCV infection is a risk of atherosclerosis. Role of HCV and HCV-related steatosis

      Abstract

      Objectives

      HCV and NAFLD are associated with atherosclerosis in general population. The prevalence of atherosclerosis in chronic hepatitis C (CHC) patients is unknown. We hypothesized that HCV per se and HCV-related steatosis could favour atherosclerosis. Thus, in CHC patients we assessed: (a) the prevalence of atherosclerosis; (b) the role of HCV, cardio-metabolic risk factors and hepatic histology.

      Methods

      Overall, 803 subjects were enrolled: (A) 326 patients with liver biopsy-proven treatment naive CHC (175 with and 151 without steatosis); (B) 477 age and gender matched controls, including 292 healthy subjects without steatosis (B1) and 185 with NAFLD (B2). Carotid atherosclerosis (CA), assessed by high-resolution B-mode ultrasonography, was categorized as either intima-media thickness (IMT: >1 mm) or plaques (≥1.5 mm).

      Results

      CHC patients had a higher prevalence of CA than controls (53.7% vs 34.3%; p < 0.0001). Younger CHC (<50 years) had a higher prevalence of CA than controls (34.0% vs 16.0%; p < 0.04). CHC patients without steatosis had a higher prevalence of CA than B1 controls (26.0% vs 14.8%; p < 0.02). CHC with steatosis had a higher prevalence of CA than NAFLD patients (77.7% vs 57.8%, p < 0.0001). Viral load was associated with serum CRP and fibrinogen levels; steatosis with metabolic syndrome, HOMA-IR, hyperhomocysteinemia and liver fibrosis. Viral load and steatosis were independently associated with CA. Diabetes and metabolic syndrome were associated with plaques.

      Conclusion

      HCV infection is a risk factor for earlier and facilitated occurrence of CA via viral load and steatosis which modulate atherogenic factors such as inflammation and dysmetabolic milieu.

      Highlights

      • CHC patients have an earlier and a higher prevalence of atherosclerosis than general population.
      • HCV RNA and HCV-related steatosis are the independent factors associated with atherosclerosis.
      • HCV and steatosis promote atherogenesis through inflammation and metabolic changes.
      • CHC patients should be screened routinely for asymptomatic atherosclerosis.

      Abbreviations:

      CHC (chronic hepatitis C), IMT (carotid intima-media thickness), HOMA-IR (homeostatic model assessment), IR (insulin resistance), HCV (hepatitis C virus), HCV RNA (hepatitis C virus RNA), HAI (histological activity index), CRP (C reactive protein)

      Keywords

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      Linked Article

      • Hepatitis C virus and atherosclerosis in a close and dangerous liaison
        AtherosclerosisVol. 221Issue 2
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          The Framingham risk scores (FRS), proposed more than 50 years ago, is still widely used as a tool for coronary risk stratification. However, a significant proportion of individuals who develop cardiovascular disease (CVD) have average levels of the established risk factors, such as hypertension, diabetes, hypercholesterolemia and smoking habit [1], and as a result, the sensitivity and specificity of the FRS do not exceed 70% and 82%, respectively [1,2]. This lack of sensitivity and specificity has focused interest on additional biological determinants that may improve prediction of CVD events, a great number of new emerging determinants are continuously proposed and their relevance debated.
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