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

Fanny Domont; Patrice Cacoub


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

In This Article

HCV Infection and Cerebrovascular Involvement

Several recent publications have reported the association between hepatitis C and the occurrence of cerebrovascular accidents (CVA) (Table 2). A prospective Taiwanese study over a 17-year period estimated a 1% risk of mortality from CVA in HCV seronegative subjects vs 2.7% in those who were seropositive, with a HR of 2.18 (95% CI: 1.5–3.16; P < 0.001) after adjusting for common CVA risk factors.[31] There was a correlation between the increased CVA risk and the extent of viral replication (HCV RNA). Conversely, a very recent Italian case–control study found an HCV seroprevalence of 26.8% in patients hospitalized for a CVA vs 6.6% in controls (P = 0.0001).[32] Patients with HCV infection compared to HCV-negative controls were younger and had lower cholesterol and triglyceride levels whereas they had higher levels of serum inflammatory markers (CRP, fibrinogen). In multivariate analysis, HCV infection was an independent risk factor of ischaemic CVA (OR 2.02; 95% CI: 1.69–2.46; P = 0.0001). Inflammation could play a key role in atheromatous plaque instability. A longitudinal cohort study conducted in Taiwan also showed that HCV infection independently increases the risk of CVA, with a hazard ratio adjusted for common cardiovascular risk factors of 1.27 (95% CI: 1.14–1.41).[33] The only study that did not find an association between CVA and HCV is difficult to interpret, since there are many confounding factors that differ significantly between the HCV-positive group and the HCV seronegative patients.[34]