Risk of Cardiovascular Disease Due to Chronic Hepatitis C Infection: A Review

Abstract

Hepatitis C (HCV) infection has an estimated global prevalence of 2.5%, causing chronic liver disease in 170 million people worldwide. Recent data has identified HCV infection as a risk factor for subclinical and clinical cardiovascular disease (CVD), but these data have been mixed and whether HCV is an independent risk factor for development of CVD remains controversial. In this review, we present the literature regarding the association of HCV with subclinical and clinical CVD and the possible underlying mechanisms leading to increased CVD among those infected with HCV. HCV infection leads to increased CVD via direct and indirect mechanisms with chronic inflammation, endothelial dysfunction and direct invasion of the arterial wall cited as possible mechanisms. Our review showed that HCV infection, particularly chronic HCV infection, appears to lead to increased subclinical CVD most consistently and potentially also to increased clinical CVD outcomes, leading to increased morbidity and mortality. Furthermore, the majority of studies evaluating the impact of HCV therapy on CVD morbidity and mortality showed an improvement in subclinical and clinical CVD endpoints in patients who were successfully treated and achieved sustained viral suppression. These results are of particular interest following the development of new direct antiviral agents which have made HCV eradication simple and feasible for many more patients globally, and in doing so may possibly reduce CVD morbidity and mortality in those with chronic HCV infection.

Inflammatory and cardiovascular diseases biomarkers in chronic hepatitis C virus infection: A review

“…Another advantage of some nontraditional biomarkers is their relationship to CHC disease stage, response to HCV treatment and achievement of SVR . Numerous studies have reported decreased CVD clinical endpoints and mortality with HCV therapy . There were conflicting results about the change of these biomarkers in response to HCV treatment, and these differing results may have been due to heterogeneous study designs, variable study populations, and different treatment regimens among studies .…”

“…Importantly, only some studies reported on the association of the change in inflammatory and cardiac biomarkers with subclinical or clinical cardiovascular disease, thereby limiting our ability to conclude on the association of the change of these biomarkers with cardiac disease in the HCV population compared to the general population. However, the markers selected in this review have been associated with subclinical and clinical cardiovascular disease in the general population already, and CHC has been associated with subclinical and clinical cardiac disease in previous studies . Furthermore, the scope of our review did not account for the possible contribution of genetic variations leading to genetic predisposition of different ethnic groups and different HCV genotypes to CVD outcomes.…”

“…in the general population already, and CHC has been associated with subclinical and clinical cardiac disease in previous studies. 6,7 Furthermore, the scope of our review did not account for the possible contribution of genetic variations leading to genetic predisposition of different ethnic groups and different HCV genotypes to CVD outcomes. In particular polymorphisms in cytokine genes or promoter regions may affect expression of inflammatory mediators and hence may affect CVD risk.…”

Association between chronic hepatitis C virus infection and myocardial infarction in people living with HIV in the United States

“…A large body of literature has linked CVD to chronic infection with hepatitis C virus (HCV), a common viral infection impacting an estimated 10 to 30% (22)(23)(24)(25)(26) of PLWH in the United States (US). Observational evidence supports an association between HCV and clinically evident CVD, in both the general population (27,28) and in PLWH (29). Yet studies in the general population focusing on the role of HCV in coronary artery disease risk are inconclusive (27) and, when restricting to MI only, have generally not supported an association (30)(31)(32)(33).…”

Human T lymphotropic virus type 1 and risk of cardiovascular disease: High‐density lipoprotein dysfunction versus serum HDL‐C concentrations

“…A growing body of genetic and clinical evidence suggests that chronic viral infections such as HIV and hepatitis virus infections are related to heightened inflammation and CVD prevalence [23,24]. It has also been demonstrated that subjects with HTLV1 infection have increased inflammation in various tissues [25].…”