Persistent augmentation of central arterial stiffness following viral clearance by direct‐acting antivirals in chronic hepatitis C

Abstract

Chronic hepatitis C virus (HCV) infection is associated with risk of cardiovascular diseases. Although direct‐acting antivirals (DAA) result in rapid eradication of HCV, their long‐term impact on arterial stiffness remains unclear. This study aimed to evaluate changes in parameters of central arterial stiffness from pretreatment, through sustained virological response, to one year after viral clearance. Patients with chronic HCV receiving DAA treatment were enrolled prospectively. Medical history and comorbidities of all patients were collected. Lipid profiles, liver stiffness by transient elastography and central blood pressures using pulse wave analysis of the brachial artery by cuff sphygmomanometry were measured before treatment, at viral clearance and at one year following viral clearance. Augmentation index (AIx), a parameter of aortic stiffness, was calculated as the ratio of augmentation pressure to central pulse pressure. After DAA treatment, all included patients with chronic HCV (n = 102) had achieved viral clearance. Cholesterol, low‐density lipoprotein (LDL) and triglyceride/high‐density lipoprotein (TG/HDL) increased significantly at viral clearance and persisted at one year (all P < .001). AIx was also elevated significantly at viral clearance and persisted one year later (P < .001). Changes in AIx remained significant only in patients with increased values from baseline in either LDL (P < .01) or TG/HDL (P < .001). Central arterial stiffness and lipid profiles in patients with chronic HCV worsen immediately after viral eradication by DAA treatment and persist at one year. Worsening of lipid profiles after DAA treatment contributes to central arterial stiffness in this patient population and persists long term.

Assessment of Changes in Liver Fibrosis and Stiffness, Lipid Profile and Insulin Resistance in Patients with Chronic Hepatitis C Viral Infection Who Received Direct Acting Antiviral Therapy

“…These changes were noticed among all patients. These results were also consistent with previous reports of other authors (11,15,(20)(21) . The direct link between HCV and host lipoproteins explicates the significant interrelationship between HCV and host lipid metabolism, as proved both in vitro and in clinical studies (22) .…”

“…Mean of the patients was 58 ± 10 years and majority (61.5%) of those patients were males. In contrast, previous studies reported female predominance among their patients (10)(11) . These discrepancies in sex predominance in different studies may be attributed to selection bias, sample size, different genotypes and race.…”

“…The direct link between HCV and host lipoproteins explicates the significant interrelationship between HCV and host lipid metabolism, as proved both in vitro and in clinical studies (22) . The rapid and sustained changes in cholesterol, LDL and TG are most likely a result from the increased delivery of lipids from the liver to blood circulation after viral eradication by DAA treatment (11) . This effect may be attributed to a reversal of the impact of HCV replication on hepatic lipid metabolism (23) .…”

Impact of DAA Treatment on Cardiovascular Disease Risk in Chronic HCV Infection: An Update

“…In addition, lipid metabolism has been reported to have been negatively impacted by the achievement of SVR by DAAs with a significant increase in LDL-C, a well-known major factor in the development of heart disease. Along this adverse effect on the lipid profile, the eradication of HCV is accompanied with an increased central arterial stiffness, a condition associated with deleterious vascular phenotypes in several diseases, such as atherosclerosis and renal disease ( Chen et al, 2021 ). In addition, DAA-treated patients exhibit an increase in body weight due to the improvement of general metabolic status.…”

The Impact of Steatosis on Chronic Hepatitis C Progression and Response to Antiviral Treatments

“…While numerous studies have indeed confirmed an improvement in CV events due to DAA-induced SVR [126][127][128], others argue that DAAs may exert a cardiotoxic effect particularly in HCV-infected patients whose left-ventricular function is impaired [129]. Chen et al further emphasized that HCV eradication by DAAs may negatively impact lipid metabolism, thereby significantly increasing LDL-C and central arterial stiffness, which are significant predictors of hypertension and CVD [130]. On another note, virus eradication with DAA regimens is linked to an improvement in parameters of glucose metabolism and IR [131,132].…”