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World J Hepatol. Sep 8, 2015; 7(19): 2214-2219
Published online Sep 8, 2015. doi: 10.4254/wjh.v7.i19.2214
Assessing cardiovascular risk in hepatitis C: An unmet need
Javier Ampuero, Manuel Romero-Gómez
Javier Ampuero, Manuel Romero-Gómez, Intercentre Unit of Digestive Diseases, Virgen Macarena - Virgen del Rocio University Hospitals. 41013 Sevilla, Spain
Author contributions: Ampuero J and Romero-Gómez M contributed to this paper.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Javier Ampuero, MD, PhD, Intercentre Unit of Digestive Diseases, Virgen Macarena - Virgen del Rocio University Hospitals. Avenida Manuel Siurot, s/n, 41013 Sevilla, Spain. javi.ampuero@gmail.com
Telephone: +34-955-015761 Fax: +34-955-015899
Received: January 29, 2015
Peer-review started: January 30, 2015
First decision: March 20, 2015
Revised: April 13, 2015
Accepted: August 30, 2015
Article in press: August 31, 2015
Published online: September 8, 2015
Processing time: 222 Days and 22.3 Hours
Abstract

Chronic hepatitis C virus (HCV) is associated with significant morbidity and mortality, as a result of the progression towards cirrhosis and hepatocellular carcinoma. Additionally, HCV seems to be an independent risk factor for cardiovascular diseases (CVD) due to its association with insulin resistance, diabetes and steatosis. HCV infection represents an initial step in the chronic inflammatory cascade, showing a direct role in altering glucose metabolism. After achieving sustained virological response, the incidence of insulin resistance and diabetes dramatically decrease. HCV core protein plays an essential role in promoting insulin resistance and oxidative stress. On the other hand, atherosclerosis is a common disease in which the artery wall thickens due to accumulation of fatty deposits. The main step in the formation of atherosclerotic plaques is the oxidation of low density lipoprotein particles, together with the increased production of proinflammatory markers [tumor necrosis factor-α, interleukin (IL)-6, IL-18 or C-reactive protein]. The advent of new direct acting antiviral therapy has dramatically increased the sustained virological response rates of hepatitis C infection. In this scenario, the cardiovascular risk has emerged and represents a major concern after the eradication of the virus. Consequently, the number of studies evaluating this association is growing. Data derived from these studies have demonstrated the strong link between HCV infection and the atherogenic process, showing a higher risk of coronary heart disease, carotid atherosclerosis, peripheral artery disease and, ultimately, CVD-related mortality.

Keywords: Hepatitis C; Atherosclerosis; Coronary artery disease; Cardiovascular risk; Oxidative stress; Inflammation

Core tip: Chronic hepatitis C is associated with significant morbidity and mortality, as a result of the progression towards cirrhosis and hepatocellular carcinoma. Furthermore, hepatitis C virus seems to be an independent risk factor for cardiovascular diseases due to its association with insulin resistance, diabetes and steatosis. The advent of new direct acting antiviral therapy has dramatically increased the sustained virological response rates of hepatitis C infection. In this scenario, the cardiovascular risk has emerged and represents a major concern after achieving the eradication of the virus.