Chronic Hepatitis C Virus Infection, a New Cardiovascular Risk Factor?

Fanny Domont; Patrice Cacoub

Disclosures

Liver International. 2016;36(5):621-627. 

In This Article

Abstract and Introduction

Abstract

Among the large scope of extrahepatic manifestations related to hepatitis C virus (HCV) infection, many studies recently evaluated the frequency and characteristics of cardiovascular involvement. To assess the current published data on HCV infection and cardiovascular diseases. Published studies on cardiovascular disease, i.e. cerebrovascular accident and ischaemic heart disease in subjects with HCV infection were analysed from literature databases. Subjects with HCV chronic infection have an increased prevalence of carotid atherosclerosis and increased intima-media thickness compared to healthy controls or those with hepatitis B or non-alcoholic steatohepatitis. Active chronic HCV infection appears as an independent risk factor for ischaemic cerebrovascular accidents. Active chronic HCV infection is associated with increased risk of ischaemic heart disease. In some studies, successful interferon-based therapy showed a beneficial impact on the cardiovascular risk. The risk of major cardiovascular events is higher in patients with HCV infection compared to controls, independent of the severity of the liver disease or the common cardiovascular risk factors. The beneficial impact of interferon-based therapy needs to be confirmed with new direct antiviral interferon-free agents in prospective studies with extended follow-up

Introduction

In addition to common cardiovascular risk factors (i.e. diabetes, hypertension, obesity, smoking, dyslipidemia, etc.), there appears to be new risk factors associated with certain infectious agents. Several infectious agents, notably Chlamydia pneumoniae, Cytomegalovirus and Human Immunodeficiency Virus (HIV), have been associated with the occurrence of cardiovascular manifestations. Hepatitis C virus (HCV) infection has been associated to a very large number of extrahepatic manifestations in various tissues and organs.[1…6] Some authors have hypothesized that infections could contribute to the inflammatory cascade and result in atherosclerosis.[7] Associations have been found between HCV infection and cardiomyopathies;[8,9] coronary[10,11] or carotid[12,13] atherosclerosis; and hypertension.[14] A recent epidemiological study showed that blood donors who were seropositive for HCV had higher mortality rates for cardiovascular diseases than non-HCV-infected blood donors without comorbidities.[15] The pathogenic mechanisms connecting HCV infection, chronic liver disease and atherogenesis are not completely understood. It has been hypothesized that HCV may promote atherogenesis and its complications through several direct and indirect biological mechanisms involving HCV colonization and replication within arterial walls, liver steatosis and fibrosis, enhanced and imbalanced secretion of inflammatory cytokines, oxidative stress, endotoxemia, perturbed cellular and humoral immunity, hyperhomocysteinemia, insulin resistance, type 2 diabetes…

As cardiovascular risk factors rates increase with age and patients with HCV chronic infection ageing, it seems of major interest to assess the impact of HCV infection on the occurrence of cardiovascular events. This review assesses the current published data on HCV infection and cardiovascular diseases.

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