Improvement of Carotid Atherosclerosis and Peripheral Artery Disease After Hepatitis C Virus Eradication by Direct-acting Antivirals

Overview

Journal Rom J Morphol Embryol

Specialties Anatomy & Histology
Cell Biology
Reproductive Medicine

Date 2024 Jan 7

PMID 38184828

Authors

Tudor Cuciureanu

Carol Stanciu

Robert Radu Nastasa

Larisa Ermina Stratina

Horia Octav Minea

Ioan Sebastian Zenovia

Catalin Sfarti

Cristina Maria Muzica

Laura Huiban

Remus Theodor Stafie

Ana Maria Singeap

Stefan Chiriac

Eliza Camelia Cojocariu

Irina Girleanu

Oana Cristina Petrea

Sergiu Timofeiov

Iulian Dan Cuciureanu

Adrian Rotaru

Anca Trifan

Affiliations

Soon will be listed here.

Abstract

Introduction: Recent research points to a link between chronic hepatitis C virus (HCV) infection and cardiovascular disease, especially carotid atherosclerosis, and suggests that HCV clearance may impact cardiovascular outcomes.

Aim: To determine if viral eradication by the new oral direct-acting antiviral (DAA) agents has benefit regarding carotid atherosclerosis, peripheral artery disease (PAD), steatosis, and liver fibrosis.

Patients, Materials And Methods: We conducted a prospective study on 168 patients diagnosed with chronic HCV infection or HCV-related cirrhosis. They were all treated with DAAs, with sustained virological response (SVR). Laboratory data, vibration-controlled transient elastography (VCTE), carotid intima-media thickness (IMT) measurement, and ankle-brachial index (ABI) were recorded in all patients.

Results: We found an average IMT of 1.22±0.2 mm, with a variance range from 1.14±0.19 mm in the mild and moderate fibrosis (≤F2) group to 1.29±0.25 mm in the severe fibrosis (≥F3) group. Also, patients with severe fibrosis (≥F3) present a more critical decrease of IMT values, with the carotid thickness affecting only 18.2% of individuals in the follow-up period. At the baseline, the best values of ABI were recorded in patients having F1-F2 fibrosis stage (mean value 1.02±0.19). Instead, in the group with severe fibrosis, the average value of ABI was lower (0.91±0.16) at the baseline, with a significant increase at SVR evaluation (p<0.001).

Conclusions: Our research highlights the beneficial effect of viral eradication on both carotid atherosclerosis and PAD, especially in those with advanced fibrosis and cirrhosis.

References

Petta S, Maida M, Macaluso F, Barbara M, Licata A, Craxi A . Hepatitis C Virus Infection Is Associated With Increased Cardiovascular Mortality: A Meta-Analysis of Observational Studies. Gastroenterology. 2015; 150(1):145-155.e4. DOI: 10.1053/j.gastro.2015.09.007. View

Arase Y, Suzuki F, Suzuki Y, Akuta N, Kobayashi M, Kawamura Y . Sustained virological response reduces incidence of onset of type 2 diabetes in chronic hepatitis C. Hepatology. 2009; 49(3):739-44. DOI: 10.1002/hep.22703. View

European Association For The Study Of The Liver . Corrigendum to 'EASL recommendations on treatment of hepatitis C: Final update of the series [J Hepatol 73 (2020) 1170-1218]. J Hepatol. 2022; 78(2):452. DOI: 10.1016/j.jhep.2022.10.006. View

Leskinen Y, Lehtimaki T, Loimaala A, Lautamatti V, Kallio T, Huhtala H . Carotid atherosclerosis in chronic renal failure-the central role of increased plaque burden. Atherosclerosis. 2003; 171(2):295-302. DOI: 10.1016/j.atherosclerosis.2003.08.010. View

Chang M . Metabolic alterations and hepatitis C: From bench to bedside. World J Gastroenterol. 2016; 22(4):1461-76. PMC: 4721980. DOI: 10.3748/wjg.v22.i4.1461. View

Hsu Y, Lin J, Ho H, Kao Y, Huang Y, Hsiao N . Antiviral treatment for hepatitis C virus infection is associated with improved renal and cardiovascular outcomes in diabetic patients. Hepatology. 2013; 59(4):1293-302. DOI: 10.1002/hep.26892. View

Hsu Y, Muo C, Liu C, Tsai W, Hsu C, Sung F . Hepatitis C virus infection increases the risk of developing peripheral arterial disease: a 9-year population-based cohort study. J Hepatol. 2014; 62(3):519-25. DOI: 10.1016/j.jhep.2014.09.022. View

Mansia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G . 2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Blood Press. 2007; 16(3):135-232. DOI: 10.1080/08037050701461084. View

Butt A, Xiaoqiang W, Budoff M, Leaf D, Kuller L, Justice A . Hepatitis C virus infection and the risk of coronary disease. Clin Infect Dis. 2009; 49(2):225-32. PMC: 3077953. DOI: 10.1086/599371. View

10.

Kobayashi N, Iijima H, Tada T, Kumada T, Yoshida M, Aoki T . Changes in liver stiffness and steatosis among patients with hepatitis C virus infection who received direct-acting antiviral therapy and achieved sustained virological response. Eur J Gastroenterol Hepatol. 2018; 30(5):546-551. DOI: 10.1097/MEG.0000000000001106. View

11.

Sasso M, Beaugrand M, de Ledinghen V, Douvin C, Marcellin P, Poupon R . Controlled attenuation parameter (CAP): a novel VCTE™ guided ultrasonic attenuation measurement for the evaluation of hepatic steatosis: preliminary study and validation in a cohort of patients with chronic liver disease from various causes. Ultrasound Med Biol. 2010; 36(11):1825-35. DOI: 10.1016/j.ultrasmedbio.2010.07.005. View

12.

Petta S, Adinolfi L, Fracanzani A, Rini F, Caldarella R, Calvaruso V . Hepatitis C virus eradication by direct-acting antiviral agents improves carotid atherosclerosis in patients with severe liver fibrosis. J Hepatol. 2018; 69(1):18-24. DOI: 10.1016/j.jhep.2018.02.015. View

13.

Benedetto F, Mallamaci F, Tripepi G, Zoccali C . Prognostic value of ultrasonographic measurement of carotid intima media thickness in dialysis patients. J Am Soc Nephrol. 2001; 12(11):2458-2464. DOI: 10.1681/ASN.V12112458. View

14.

Innes H, McDonald S, Dillon J, Allen S, Hayes P, Goldberg D . Toward a more complete understanding of the association between a hepatitis C sustained viral response and cause-specific outcomes. Hepatology. 2015; 62(2):355-64. DOI: 10.1002/hep.27766. View

15.

Dore G, Ward J, Thursz M . Hepatitis C disease burden and strategies to manage the burden (Guest Editors Mark Thursz, Gregory Dore and John Ward). J Viral Hepat. 2014; 21 Suppl 1:1-4. DOI: 10.1111/jvh.12253. View

16.

Trifan A, Stratina E, Rotaru A, Stafie R, Zenovia S, Nastasa R . Changes in Liver Steatosis Using Controlled Attenuation Parameter among Patients with Chronic Hepatitis C Infection Treated with Direct-Acting Antivirals Therapy Who Achieved Sustained Virological Response. Diagnostics (Basel). 2022; 12(3). PMC: 8947513. DOI: 10.3390/diagnostics12030702. View

17.

Lorenz M, Schaefer C, Steinmetz H, Sitzer M . Is carotid intima media thickness useful for individual prediction of cardiovascular risk? Ten-year results from the Carotid Atherosclerosis Progression Study (CAPS). Eur Heart J. 2010; 31(16):2041-8. DOI: 10.1093/eurheartj/ehq189. View

18.

White D, Ratziu V, El-Serag H . Hepatitis C infection and risk of diabetes: a systematic review and meta-analysis. J Hepatol. 2008; 49(5):831-44. PMC: 2642971. DOI: 10.1016/j.jhep.2008.08.006. View

19.

Lau K, Chan Y, Yiu K, Tam S, Li S, Lau C . Incremental predictive value of vascular assessments combined with the Framingham Risk Score for prediction of coronary events in subjects of low-intermediate risk. Postgrad Med J. 2008; 84(989):153-7. DOI: 10.1136/pgmj.2007.064089. View

20.

Oyama J, Murohara T, Kitakaze M, Ishizu T, Sato Y, Kitagawa K . The Effect of Sitagliptin on Carotid Artery Atherosclerosis in Type 2 Diabetes: The PROLOGUE Randomized Controlled Trial. PLoS Med. 2016; 13(6):e1002051. PMC: 4924847. DOI: 10.1371/journal.pmed.1002051. View