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Chronic HCV infection is a risk factor of ischemic stroke

  • Luigi E. Adinolfi
    Correspondence
    Corresponding author. Clinical Hospital of Marcianise, Second University of Naples, 81025 Marcainise (CE), Italy.
    Affiliations
    Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy
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  • Luciano Restivo
    Affiliations
    Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy
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  • Barbara Guerrera
    Affiliations
    Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy
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  • Ausilio Sellitto
    Affiliations
    Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy
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  • Antonella Ciervo
    Affiliations
    Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy
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  • Natalina Iuliano
    Affiliations
    Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy
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  • Luca Rinaldi
    Affiliations
    Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy
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  • Aldo Santoro
    Affiliations
    Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy
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  • Giovanni Li Vigni
    Affiliations
    Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy
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  • Aldo Marrone
    Affiliations
    Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy
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      Highlights

      • Patients with ischemic stroke have a significant higher prevalence of HCV infection than controls.
      • Irrespective of traditional stroke risk factors, HCV is associated with ischemic stroke.
      • The results support a role of HCV in the development of ischemic stroke.
      • Chronic inflammation is associated with HCV infection and seems to have a pathogenic role.

      Abstract

      Objectives

      Cerebrovascular diseases are leading cause of death worldwide. Plaque rupture and embolization account for one-third of ischemic stroke. The causes are not fully known, but inflammation plays a pathogenic role. Recently, HCV infection has been identify as risk of atherosclerosis. HCV replicates within carotid plaques and brain endothelia cells; moreover, HCV patients showed higher levels of inflammation. Thus, we hypothesized that subjects carrying HCV are at higher risk of stroke. Accordingly, we evaluated prevalence and role of HCV infection in patients with stroke.

      Methods

      A priori sample size was calculated. Overall, 820 consecutive patients were enrolled, 123 with stroke and, as control, 697 age- and gender-matched (295 with COPD; 402 with diseases other than HCV-associated). Patients were evaluated for HCV and conventional risk of stroke.

      Results

      Prevalence of HCV was higher in patients with stroke than that observed in control (26.8% vs. 6.6%, p = 0.0001). An analysis of stroke patients showed that those HCV positive were younger (p = 0.017) had lower serum levels of cholesterol (p = 0.001), triglycerides (p = 0.045), and higher serum levels of inflammation markers (ESR, p = 0.001; CRP, p = 0.0001; fibrinogen, p = 0.012). A multivariate analysis showed that HCV infection was an independent risk factor of stroke (O.R. 2.04, 95% C.I. 1.69–2.46; p = 0.0001). A secondary analysis showed that HCV patients had higher (p = 0.031) prevalence of past ischemic heart disease.

      Conclusions

      HCV infected patients are at higher and earlier risk of stroke. Inflammation is a key mediator. Clinicians in clinical practice and researchers in future trials should take into account these new findings.

      Keywords

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