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

Impact of HCV Treatment on Cardiovascular Outcomes

Few studies have evaluated the effect of Pegylated interferon α plus ribavirin (Interferon-Based Therapy), the standard of care treatment for chronic HCV infection before the advent of new direct acting antiviral therapy, on main cardiovascular outcomes.

A retrospective study from the Taiwan National Health Insurance Program included 3113 subjects with a newly detected HCV infection and 12 452 age- and gender-matched subjects without HCV infection followed up to 5 years.[49] Use of IBT significantly reduced the risk of stroke in HCV patients (adjusted HR = 0.39, 95% CI: 0.16–0.95, P = 0.039) after adjusting for known prognostic factors. Another Taiwanese study showed IBT to be associated with improved cardiovascular outcomes in HCV-infected diabetic patients.[50] After a mean follow up of 8 years, the cumulative incidence of CVA in HCV-seropositive diabetic patients significantly decreased after treatment with IBT 3.1% (95% CI: 1.1–5.0%) compared to non-treated HCV-infected diabetics (5.3%; 95% CI: 3.0–7.5%) or diabetic HCV-seronegative subjects (6.1%; 95% CI: 4.8–7.4%). In another study from the Taiwan nationwide cohort, 12 384 HCV patients treated with IBT matched 1:2 with 24 768 untreated controls showed a 8-year cumulative incidence of stroke of 1.31% vs 1.76% (P = 0.001). Of note, the multivariate analysis showed that a 16 weeks IBT was associated with a lower risk of stroke (HR 0.62, 95% CI: 0.46–0.83; P = 0.001) and of acute coronary disease (HR 0.77, 95% CI: 0.62–0.97; P = 0.01).[51] Such beneficial cardiovascular impact was not found in patients who received <16 weeks IBT. Use of IBT in chronic hepatitis C seems to reduce the risk of stroke as well as non-liver related mortality.[20]

Other studies showed beneficial impact of IBT on surrogate markers of atherosclerosis. A cross-sectional study showed that HCV patients who achieved a SVR compared to non-SVR patients had a significant improvement in their arterial stiffness as measured by pulse wave velocity (7.4 ± 1.1 vs 6.5 ± 0.6 m/s, respectively).[47] A Spanish study included 56 patients, 32 HCV-HIV co-infected and 24 HCV mono-infected. Compared with baseline, during IBT therapy there was a significant decrease in the concentrations of matrix metalloproteinase-9 (P < 0.001), intercellular cell adhesion molecule-1 (ICAM-1) (P ≤ 0.01) and oxidized low-density lipoproteins (P = 0.002).[52] After IBT discontinuation, levels of ICAM-1, VCAM-1 and tumour necrosis factor-α were significantly lower compared with baseline, a change restricted to patients with sustained virological response.

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