Associations of chronic hepatitis C with metabolic and cardiac outcomes

Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.73). 02/2013; 37(6). DOI: 10.1111/apt.12234
Source: PubMed


BACKGROUND: Chronic hepatitis C virus (CH-C) infection is associated with metabolic conditions such as insulin resistance and type 2 diabetes (DM) and may increase the risk of cardiovascular diseases. AIM: To assess the association of CH-C with risk factors for cardiovascular diseases using US population data. METHODS: The National Health and Nutrition Examination Surveys (NHANES) collected between 1999 and 2010 were used. RESULTS: A total of 19 741 participants were considered eligible for the study. Of this cohort, 173 individuals (0.88%) had detectable HCV RNA and were considered to have CH-C. Compared with controls, CH-C patients were predominantly African American (23.5% vs. 10.5%, P < 0.0001), men (66.6% vs. 46.1%, P = 0.0001), more likely to be between 45 and 55 years of age (41.9% vs. 20.4%, P = 0.0001), had higher rate of insulin resistance (44.1% vs. 31.1%, P = 0.0301), hypertension (40.1% vs. 28.9%, P = 0.0201), and history of smoking (76.2% vs. 29.9%, P < 0.0001). In multivariate analysis, in addition to known risk factors for insulin resistance, CH-C was independently associated with the presence of insulin resistance [OR (95% CI) = 2.06 (1.19-3.57)], DM [OR = 2.31 (1.18-4.54)] and hypertension [OR = 2.06 (1.30-3.24)]. In addition, independent predictors of cardiovascular diseases included older age, presence of obesity and smoking. Furthermore, CH-C was independently associated with congestive heart failure subtype of cardiovascular diseases but not ischaemic heart disease and stroke. CONCLUSIONS: Chronic hepatitis C virus infection is independently associated with presence of metabolic conditions (insulin resistance, type 2 diabetes and hypertension) and congestive heart failure.

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    • "Furthermore, approximately 50% of all deaths in those with known HCV had liver disease listed on the death certificate. Thus, even if we exclude other diseases associated with HCV infection such as diabetes and non-Hodgkin lymphoma23242526, it appears that most are dying not just with HCV but from HCV. These considerations are especially important because identifying and treating HCV patients in an era of rapidly evolving and effective curative therapies could have a major public health impact. "
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    ABSTRACT: Background. The number of deaths in hepatitis C virus (HCV)-infected persons recorded on US death certificates has been increasing, but actual rates and causes of death in these individuals have not been well elucidated.Methods. Disease-specific, liver-related, and non-liver-related mortality data for HCV-infected patients in an observational cohort study, the Chronic Hepatitis Cohort Study (CHeCS) at 4 US healthcare systems, were compared with multiple cause of death (MCOD) data in 12 million death certificates in 2006-2010. Premortem diagnoses, liver biopsies, and FIB-4 scores (a noninvasive measure of liver damage) were examined.Results. Of 2 143 369 adult patients seen at CHeCS sites in 2006-2010, 11 703 (0.5%) had diagnosed chronic HCV infection, and 1590 (14%) died. The majority of CHeCS decedents were born from 1945 to 1965 (75%), white (50%), and male (68%); mean age of death was 59 years, 15 years younger than MCOD deaths. The age-adjusted mortality rate for liver disease in CHeCS was 12 times higher than the MCOD rate. Before death, 63% of decedents had medical record evidence of chronic liver disease, 76% had elevated FIB-4 scores, and, among those biopsied, 70% had moderate or worse liver fibrosis. However, only 19% of all CHeCS decedents and only 30% of those with recorded liver disease had HCV listed on their death certificates.Conclusions. HCV infection is greatly underdocumented on death certificates. The 16 622 persons with HCV listed in 2010 may represent only one-fifth of about 80 000 HCV-infected persons dying that year, at least two-thirds of whom (53 000 patients) would have had premortem indications of chronic liver disease. © 2014 Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.
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    • "Several studies reported that HCV infection may also contribute to the development of diabetes, and higher prevalence of type 2 diabetes mellitus has been observed in the developed world (2% to 9.4%) in patients with HCV infection than in those with other forms of chronic hepatitis [9] [10] [11] [12]. This association between HCV infection and diabetes was for the first time made by Allison et al. in 1994 [13]. "
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    ABSTRACT: Purpose: The study was aimed to investigate the frequency of diabetes mellitus type 2 in patients infected with chronic hepatitis C virus and its association with cirrhosis. Patients and methods: This prospective case series was conducted at Section of Gastroenterology and Hepatology, Isra University Hospital, Hyderabad, over a period of 4 months from June 2009 to October 2009. Hepatitis C virus seropositive patients who were older than 18 years, diabetic or nondiabetic, were included. Basic demographic data collected by questionnaire and laboratory investigations including fasting blood glucose levels, serum cholesterol, and liver function tests were done. A logistic regression model was used to explore the association between diabetic and nondiabetic HCV seropositives and type 2 diabetes mellitus with cirrhosis. Results: A total of 361 patients with hepatitis C were analyzed; the prevalence of type 2 diabetes mellitus in HCV patients was 31.5%. Out of the total number of the participants, 58.4% (n = 211) were cirrhotics, while 41.6% (n = 150) were noncirrhotic HCV seropositives. In multivariate analysis, cirrhotic patients appeared significantly more likely (P = 0.01) to be diabetic as compared with noncirrhotic patients (OR = 2.005, 95% CI: 1.15, 3.43). Conclusion: Advancing age, increased weight, and HCV genotype 3 are independent predictors of type 2 diabetes in HCV seropositive patients, and there is a statistically significant association of cirrhosis observed with type 2 diabetes mellitus.
    Full-text · Article · Aug 2013 · Journal of Diabetes Research
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    • "In this line, Adinolfi and colleagues recently observed that also viral load and hepatic steatosis are associated with the presence of carotid atherosclerosis in CHC subjects, thus assuming that HCV infection could be a relevant risk factor for carotid atherosclerosis occurrence via viral load and steatosis [94]. In contrast to these findings, Mostafa and colleagues recently demonstrated that IMT was associated with classical cardiovascular risk factors, such as systolic blood pressure and LDL cholesterol, while HCV infection was not associated [95]; a recent population-based Japanese study showed a paradoxically lower risk of atherosclerosis in CHC patients compared with healthy controls, even if an increased prevalence of IR in patients with HCV infection is confirmed [96]; Younossi and colleagues found that chronic HCV infection is independently associated with the presence of metabolic conditions (IR, T2D and hypertension) and, interestingly, with the presence of congestive heart failure, but not with increased rates of ischaemic heart disease and stroke [97]. Overall, the results of these studies highlight the presence of ambiguous data on the possible association between HCV infection and cardiovascular risk and the need for further studies in order to obtain external validation of these data in different, for example, per se “metabolic” and “nonmetabolic,” populations. "
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    ABSTRACT: In the last years, several lines of evidence showed how metabolic factors may influence the natural history of patients with chronic hepatitis C. Chronic HCV infection is able to perturb the metabolic homeostasis of the host, in a context of complex interactions where pre-existent metabolic status and genetic background play an important role, allowing us to state that HCV infection is a systemic disease. In this review, we discuss the most recent lines of evidence on the main metabolic factors that are known to be associated with CHC, namely, insulin resistance/type 2 diabetes, steatosis, visceral obesity, atherosclerosis, vitamin D, menopause, fructose and coffee intake, lipoproteins, methylenetetrahydrofolate reductase status, and hyperuricaemia. In particular, we focus on the pathophysiological mechanisms underlying the correlation between HCV infection and metabolic disorders, the impact of metabolic factors on the progression of liver and non-liver-related diseases, and, on the contrary, the possible influence of chronic HCV infection on metabolic features. In this setting, the importance of a multifaceted evaluation of CHC patients and a prompt correction of modifiable metabolic risk factors should be emphasized.
    Full-text · Article · Jul 2013
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