Analysis of the Prevalence of Cardiovascular Risk Factors in Patients with Chronic Hepatitis C
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Abstract
Cardiovascular diseases are the most common and important cause of morbidity, hospitalisation, and mortality in Poland and worldwide. Hence, in recent years there has been a strong emphasis on preventive cardiology, aimed at early identification and prevention of cardiovascular risk factors and lifestyle changes. The main classical risk factors include lipid disorders, hypertension, diabetes, obesity, and smoking. A new non-classical risk factor is HCV infection.
The study group consisted of 320 patients with a mean age of 43 years, diagnosed with chronic hepatitis C. In the study group, ischaemic heart disease was diagnosed in 4 patients, representing 1.25%. Six people had a history of ischaemic stroke, representing 1.87% of the study group.
Among the subjects, the most common cardiovascular risk factor was hyperlipidaemia (28%); there was no correlation with the severity of liver fibrosis for total cholesterol, LDL fraction, or TG, but more advanced liver fibrosis was observed in patients with low HDL fraction cholesterol values. Hypertension was present in 25% of patients and occurred in patients with more advanced liver fibrosis and steatosis. Diabetes was found in 11,56% of patients, also the mean fasting glucose level was elevated and was associated with more advanced liver fibrosis. The majority of patients were overweight and 32% were diagnosed as obese. The mean CRP value was 1.73 which may indicate moderate -cardiovascular risk.
The results obtained may contribute to the awareness of physicians and the attempt to create recommendations for comprehensive - interdisciplinary care of patients chronically infected with HCV, concerning the need for systematic periodic examinations to assess individual cardiovascular risk factors, with the aim of prevention and early prevention of cardiovascular events.
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The Global Cardiovascular Risk Consortium. Global effect of modifiable risk factors on cardiovascular disease and mortality. N Engl J Med. 2023;389:1273-1285. Available from: https://doi.org/10.1056/nejmoa2206916
Philip J, Salim Y. Coordinating efforts to reduce the global incidence of cardiovascular disease. N Engl J Med. 2023;389:1329-31. Available from: https://doi.org/10.1056/nejme2309401
Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas K, Bäck M, et al. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(37):3227-3337. https://doi.org/10.1093/eurheartj/ehab484
Catapano A, Tokgözoğlu L, Silva AM, Bruckert E. et al. Atherogenic markers in predicting cardiovascular risk and targeting residual cardiovascular risk. Atherosclerosis Suppl. 2019;39:100001. Available from: https://doi.org/10.1016/j.athx.2019.100001
Magnussen C, Leong DP, Blankenberg S. Modifiable risk factors and cardiovascular outcomes. Reply. N Engl J Med. 2023 Dec 21;389(25):2401-2402. Available from: https://www.nejm.org/doi/full/10.1056/NEJMc2312596
Zdrojewski T, Rutkowski M, Bandosz P, Gaciong Z, Jędrzejczyk T, Solnica B, et al. Prevalence and control of cardiovascular risk factors in Poland. Assumptions and objectives of the NATPOL 2011 survey. Kardiol Pol. 2013;71(5):381-392. Available from: https://doi.org/10.5603/kp.2013.0066
Zdrojewski T, Solnica B, Cybulska B, Bandosz P, Rutkowski M, Stokwiszewski J, et al. Prevalence of lipid abnormalities in Poland. The NATPOL 2011 survey. Kardiol Pol. 2016;74(3):213-223. Available from: https://doi.org/10.5603/kp.2016.0029
Jóźwiak JJ, Studziński K, Tomasik T, Windak A, Mastej M, Catapano AL, et al. LIPIDOGRAM2015 Investigators. The prevalence of cardiovascular risk factors and cardiovascular disease among primary care patients in Poland: Results from the LIPIDOGRAM2015 study. Atheroscler Suppl. 2020;e15–e24. Available from: https://doi.org/10.1016/j.atherosclerosissup.2021.01.004
Wojtyniak B, Goryński P. Sytuacja zdrowotna ludności Polski i jej uwarunkowania 2020 (Health situation of the Polish population and its determinants 2020). Warsaw, Poland: National Institute of Public Health—National Institute of Hygiene; 2020. Available from: https://www.pzh.gov.pl/wp-content/uploads/2021/01/Raport_ang_OK.pdf
Rajewski P, Zarebska-Michaluk D, Janczewska E, Gietka A, Mazur W, et al. Hepatitis C infection as a risk factor for hypertension and cardiovascular diseases: An EpiTer multicentre study. J Clin Med. 2022;11(17):5193. Available from: https://doi.org/10.3390/jcm11175193
Devarbhavi H, Asrani SK, Arab JP, Nartey YA, Pose E, Kamath PS. Global burden of liver disease: 2023 update. J Hepatol. 2023;79(3):516-537. Available from: https://doi.org/10.1016/j.jhep.2023.03.017
Polaris Observatory HCV Collaborators. Global change in hepatitis C virus prevalence and cascade of care between 2015 and 2020: A modelling study. Lancet Gastroenterol Hepatol. 2022;7(5):396-415. Available from: https://doi.org/10.1016/s2468-1253(21)00472-6
Zaltron S, Spinetti A, Biasi L, Baiguera C, Castelli F. Chronic HCV infection: Epidemiological and clinical relevance. BMV Infect Dis. 2012;12(Suppl 2):S2. Available from: https://doi.org/10.1186/1471-2334-12-s2-s2
Blach S, Razavi-Shearer D, Mooneyhan E, Estes C, Razavi-Shearer K, Gamkrelidze I, Razavi H. Updated evaluation of global progress towards HBV and HCV elimination, preliminary data through 2021. Hepatology. 2022;76(Suppl 1):S230-S231. Available from: http://dx.doi.org/10.1016/S0168-8278(22)00834-0
Rajewski P, Dulęba-Góra K, Kwiatkowska J. Przewlekłe zapalenie wątroby typu C jako choroba metaboliczna. Hepatologia. 2022;22:22–29. Available from: https://www.termedia.pl/Przewlekle-zapalenie-watroby-typu-C-dlaczego-warto-badac-anty-HCV-w-POZ,98,52096,1,0.html
Sene D, Limal N, Cacoub P. Hepatitis C virus-associated extrahepatic manifestations: A review. Metab Brain Dis. 2004;19(4):357–381. Available from: https://doi.org/10.1023/b:mebr.0000043982.17294.9b
Sterling TK, Barlow S. Extrahepatic manifestations of hepatitis C virus. Curr Gastroenterol Rep. 2006;8(1):53–59. Available from: https://doi.org/10.1007/s11894-006-0064-y
Rajewski P, Zarebska-Michaluk D, Janczewska E, Gietka A, Mazur W, Tudrujek-Zdunek M, et al. HCV genotype has no influence on the incidence of diabetes—EpiTer multicentre study. J Clin Med. 2022;11(1):379. Available from: https://doi.org/10.3390/jcm11020379
Hammerstad SS, Grock SF, Lee HJ, Hasham A, Sundaram N, Tomer Y. Diabetes and hepatitis C: A two-way association. Front Endocrinol (Lausanne). 2015;6:134. Available from: https://doi.org/10.3389/fendo.2015.00134
White DL, Ratziu V, El-Serag HB. Hepatitis C infection and risk of diabetes: A systematic review and meta-analysis. J Hepatol. 2008;49(5):831–844. Available from: https://doi.org/10.1016/j.jhep.2008.08.006
Petta S, Maida M, Macaluso FS, Barbara M, Licata A, Craxì A, et al. Hepatitis C virus infection is associated with increased cardiovascular mortality: A meta-analysis of observational studies. Gastroenterology. 2016;150(1):145–155. Available from: https://doi.org/10.1053/j.gastro.2015.09.007
Butt AA, Yan P, Chew KW, Currier J, Corey K, Chung RT, et al. Risk of acute myocardial infarction among hepatitis C virus (HCV)-positive and HCV-negative men at various lipid levels: Results from ERCHIVES. Clin Infect Dis. 2017;65(4):557–565. Available from: https://doi.org/10.1093/cid/cix359
Adinolfi LE, Petta S, Francanzani AL, Coppola C, Narciso V, Nevola R, et al. Impact of hepatitis C virus clearance by direct-acting antiviral treatment on the incidence of major cardiovascular events: A prospective multicentre study. Atherosclerosis. 2020;296:40–47. Available from: https://doi.org/10.1016/j.atherosclerosis.2020.01.010
Mehta S, Zhao J, Poppe K, Kerr AJ, Wells S, Exeter DJ, et al. Cardiovascular preventive pharmacotherapy stratified by predicted cardiovascular risk: A national data linkage study. Eur J Prev Cardiol. 2022;28(17):1905-1913. Available from: https://doi.org/10.1093/eurjpc/zwaa168
Drygas W, Niklas AA, Piwońska A, Piotrowski W, Flotyńska A, Kwaśniewska M, Nadrowski P, Puch-Walczak A, Szafraniec K, Bielecki W, et al. Multi-centre National Population Health Examination Survey (WOBASZ II study): Assumptions, methods, and implementation. Kardiol Pol. 2016;74(7):681–690.
Petta S, Adinolfi LE, Fracanzani AL, Rini F, Caldarella R, Calvaruso V, et al. 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. Available from: https://doi.org/10.1016/j.jhep.2018.02.015
Ji H, Kim A, Ebinger JE, Niiranen TJ, Claggett BL, Bairey Merz CN, et al. Sex Differences in Blood Pressure Trajectories Over the Life Course. JAMA Cardiol. 2020;5(3):19-26. Available from: https://doi.org/10.1001/jamacardio.2019.5306
Lee CMY, Mnatzaganian G, Woodward M, Chow CK, Sitas F, Robinson S, et al. Sex disparities in the management of coronary heart disease in general practices in Australia. Heart. 2019;105(24):1898-1904. Available from: https://doi.org/10.1136/heartjnl-2019-315134
Rajewski P, Pawłowska M, Kozielewicz D, Dybowska D, Olczak A, Cieściński J. Hepatitis C infection is not a cardiovascular risk factor in young adults. Biomedicines. 2024;12(10):2400. Available from: https://doi.org/10.3390/biomedicines12102400
Rajewski P, Kwiatkowska J, Nowicka-Matuszewska A, Rajewski P. Bezpieczeństwo stosowania statyn w przewlekłych chorobach wątroby. Lek POZ. 2024;10:111–117. Available from: https://www.termedia.pl/Bezpieczenstwo-stosowania-statyn-w-przewleklych-chorobach-watroby,98,54206,1,1.html
Kapadia SB, Chisari FV. Hepatitis C virus RNA replication is regulated by host geranylgeranylation and fatty acids. Proc Natl Acad Sci USA. 2005;102(8):2561–2566. Available from: https://doi.org/10.1073/pnas.0409834102
Gajewska D, Harton A. Current nutritional status of the Polish population—Focus on body weight status. J Health Inequalities. 2023;9(2):154–160. Available from: https://doi.org/10.5114/jhi.2023.133899
World Health Organization (WHO). Obesity and Overweight; World Health Organization: Geneva, Switzerland. Available online: Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Okunogbe A, Nugent R, Spencer G, Powis J, Ralston J, Wilding J. Economic impacts of overweight and obesity. 2nd Edition with estimates for 161 countries. BMJ Glob Health. 2022;7(9):e009773. Available from: https://pubmed.ncbi.nlm.nih.gov/36130777/
Hu KQ, Kyulo NL, Esrailian E, Thompson K, Chase R, Hillebrand DJ, et al. Overweight and obesity, hepatic steatosis, and progression of chronic hepatitis C: A retrospective study on a large cohort of patients in the United States. J Hepatol. 2004;40(1):147–154. https://doi.org/10.1016/s0168-8278(03)00479-3
Negro F. Mechanisms and significance of liver steatosis in hepatitis C virus infection. World J Gastroenterol. 2006;12(42):6756–6765. Available from: https://doi.org/10.3748/wjg.v12.i42.6756
Jiang LL, Li L, Hong XF, Li YM, Zhang BL. Patients with nonalcoholic fatty liver disease display increased serum resistin levels and decreased adiponectin levels. Eur J Gastroenterol Hepatol. 2009;21(10):1134–1140.
Bertolani C, Sancho-Bru P, Failli P, Bataller R, Aleffi S, DeFranco R, et al. Resistin as an intrahepatic cytokine: Overexpression during chronic injury and induction of proinflammatory actions in hepatic stellate cells. Am J Pathol. 2006;169(6):2042–2053. Available from: https://doi.org/10.2353/ajpath.2006.060081
Cua IH, Hui JM, Bandara P, Kench JG, Farrell GC, McCaughan GW, et al. Insulin resistance and liver injury in hepatitis C is not associated with virus-specific changes in adipocytokines. Hepatology. 2007;46(1):66-73. Available from: https://doi.org/10.1002/hep.21703
Piękoś-Lorenc I, Woźniak-Holecka J, Jaruga-Sękowska S. Otyłość, nadwaga i problemy psychiczne jako konsekwencje pandemii koronawirusa. In: Zdrowie i Style Życia: Ekonomiczne, Społeczne i Zdrowotne Skutki Pandemii. 2021:69–78. Available from: http://doi.org/10.34616/142082
Lecube A, Hernandez C, Genesca J, Simo R. Proinflammatory cytokines, insulin resistance, and insulin secretion in chronic hepatitis C patients: A case-control study. Diabetes Care. 2006;29(5):1096–1101. https://doi.org/10.2337/diacare.2951096
Klover PJ, Zimmers TA, Koniaris LG, Mooney RA. Chronic exposure to interleukin-6 causes hepatic insulin resistance in mice. Diabetes. 2003;52(12):2784–2789. https://doi.org/10.2337/diabetes.52.11.2784
Gallucci G, Tartarone A, Lerose R, Lalinga AV, Capobianco AM. Cardiovascular risk of smoking and benefits of smoking cessation. J Thorac Dis. 2020;12(11):3866–3876. Available from: https://doi.org/10.21037/jtd.2020.02.47
Wu AD, Lindson N, Hartmann-Boyce J, Wahedi A, Hajizadeh A, Theodoulou A, et al. Smoking cessation for secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2022;8:CD014936. Available from: https://doi.org/10.1002/14651858.cd014936.pub2
Keto J, Ventola H, Jokelainen J, Linden K, Keinänen-Kiukaanniemi S, Timonen M, et al. Cardiovascular disease risk factors in relation to smoking behaviour and history: A population-based cohort study. Open Heart. 2016;3(1): e000358. Available from: https://doi.org/10.1136/openhrt-2015-000358
Gupta R, Gupta S, Sharma S, Sinha DN, Mehrotra R. Risk of coronary heart disease among smokeless tobacco users: results of systematic review and meta-analysis of global data. Nicotine Tob Res. 2019;21(1):25–31. Available from: https://doi.org/10.1093/ntr/nty002
Topor-Madry R, Wojtyniak B, Strojek K, Rutkowski D, Boguslawski S, Ignaszewska-Wyrzykowska A, et al. Prevalence of diabetes in Poland: A combined analysis of national databases. Diabet Med. 2019;36(9):1209–1216. Available from: https://doi.org/10.1111/dme.13949
Diabetes Prevalence and Costs of the National Health Fund and Patients-A.D.; Expert Opinion Prepared by the National Institute of Public Health-PZH, the Committee for the Assessment of Diabetes Epidemiology in Poland and for the Assessment of Diabetes Costs and their Determinants in Poland, the Committee of Public Health of the Polish Academy of Sciences and PEX PharmaSequence. 2017. Available from:: https://www.pzh.gov.pl/wp-content/uploads/2020/01/Ekspertyza_cukrzyca_raport_ko%C5%84cowy.pdf
Noto H, Raskin P. Hepatitis C infection and diabetes. J Diabetes Complicat. 2006;35(5):279–283.
Zein NN, Abdulkarim AS, Wiesner RH, Egan KS, Persing DH. Prevalence of diabetes mellitus in patients with end-stage liver cirrhosis due to hepatitis C, alcohol, or cholestatic disease. J Hepatol. 2000;32(2):209–217. Available from: https://doi.org/10.1016/s0168-8278(00)80065-3
Mehta SH, Brancati FL, Sulkowski M, Strathdee S, Szklo M, Thomas D. Prevalence of type 2 diabetes mellitus among persons with hepatitis C virus infection in the United States. Ann Intern Med. 2000;133(8):592–599. Available from: https://doi.org/10.7326/0003-4819-133-8-200010170-00009
Mehta SH, Brancati FL, Strathdee SA, Pankow JS, Netski D, Coresh J, Szklo M, Thomas DL. Hepatitis C virus infection and incident type 2 diabetes. Hepatology. 2003;38(1):50–56. Available from: https://doi.org/10.1053/jhep.2003.50291
Knobler H, Zhornicky T, Sandler A, Haran N, Ashur Y, Schattner A. Tumor necrosis factor alpha induced insulin resistance may mediate the hepatitis C virus—diabetes association. Am J Gastroenterol. 2003;98(12):2751–2756. Available from: https://doi.org/10.1111/j.1572-0241.2003.08728.x
Picardi A, Gentilucci UV, Zardi EM, Caccavo D, Petitti T, Manfrini S, Pozzilli P, Afeltra A. TNF-alpha and growth hormone resistance in patients with chronic liver disease. J Interferon Cytokine Res. 2003;23(3):229–235. Available from: https://doi.org/10.1089/107999003321829944
Aytug S, Reich D, Sapiro LE, Bernstein D, Begum N. Impaired IRS-1/P13-kinase signaling in patients with HCV: A mechanism for increased prevalence of type 2 diabetes. Hepatology. 2003;38(6):1384–1392. Available from: http://dx.doi.org/10.1016/j.hep.2003.09.012
Bernsmeier C, Duong FH, Christen V, Pugnale P, Negro F, Terracciano L, et al. Virus-induced overexpression of protein phosphatase 2A inhibits insulin signalling in chronic hepatitis C. J Hepatol. 2008;49(3):429–440. Available from: https://doi.org/10.1016/j.jhep.2008.04.007
Persico M, Capasso M, Persico E, Svelto M, Russo R, Spano D, et al. Suppressor of cytokine signaling 3 (SOCS3) expression and hepatitis C virus-related chronic hepatitis: Insulin resistance and response to antiviral therapy. Hepatology. 2007;55(2):529–535.
Shah SH, Newby LK. C-reactive protein: A novel marker of cardiovascular risk. Cardiol Rev. 2003;11(4):169–179. Available from: https://doi.org/10.1097/01.crd.0000077906.74217.6e
Amezcua-Castillo E, González-Pacheco H, Sáenz-San Martín A, Méndez-Ocampo P, Gutierrez-Moctezuma I, Massó F, et al. C-Reactive Protein: The quintessential marker of systemic inflammation in coronary artery disease—Advancing toward precision medicine. Biomedicines. 2023;11(9):2444. Available from: https://doi.org/10.3390/biomedicines11092444
Lawler PR, Bhatt DL, Godoy LC, Lüscher TF, Bonow RO, Verma S, et al. Targeting cardiovascular inflammation: next steps in clinical translation. Eur Heart J. 2021;42(1):113–131. Available from: https://doi.org/10.1093/eurheartj/ehaa099
Urman A, Taklalsingh N, Sorrento C, Mcfarlane I. Inflammation beyond the joints: rheumatoid arthritis and cardiovascular disease. Scifed J Cardiol. 2018;2(3):1-23. Available from: https://www.researchgate.net/publication/329525180_Inflammation_beyond_the_Joints_Rheumatoid_Arthritis_and_Cardiovascular_Disease
Roubille F, Cherbi M, Kalmanovich E, Delbaere Q, Bonnefoy-Cudraz E, Puymirat E, et al. The admission level of CRP during cardiogenic shock is a strong independent risk marker of mortality. Sci Rep. 2024;14:16338. Available from: https://doi.org/10.1038/s41598-024-67556-y
Bhuiyan AR, Mitra AK, Ogungbe O, Kabir N. Association of HCV infection with C-reactive protein: National Health and Nutrition Examination Survey (NHANES), 2009–2010. Diseases. 2019;7(1):25. Available from: https://doi.org/10.3390/diseases7010025
Che W, Zhang B, Liu W, Wei Y, Xu Y, Hu D. Association between high-sensitivity C-reactive protein and N-Terminal Pro-B-Type Natriuretic Peptide in patients with hepatitis C virus infection. Mediat Inflamm. 2012;2012:730923. Available from: https://doi.org/10.1155/2012/730923
Salter ML, Lau B, Mehta SH, Go VF, Leng S, Kirk GD. Correlates of elevated interleukin-6 and C-reactive protein in persons with or at high risk for HCV and HIV infections. J Acquir Immune Defic Syndr. 2013;64(5):488–495. Available from: https://doi.org/10.1097/qai.0b013e3182a7ee2e
Singh S, Bansal A, Kumar P. CRP Levels in Viral Hepatitis: A Meta-Analysis Study. Int J Infect. 2021;8:e108958. Available from: https://doi.org/10.5812/iji.108958
Rajewski P, Kwiatkowska J, Nowicka-Matuszewska A, Rajewski P. Chronic hepatitis C—Why it is worth testing anti-HCV in primary care. Lek POZ. 2023;9:352–355.
Sasso FC, Pafundi PC, Caturano A, Galiero R, Vetrano E, Nevola R, et al. Impact of direct acting antivirals (DAAs) on cardiovascular events in HCV cohort with pre-diabetes. Nutr Metab Cardiovasc Dis. 2021;31(11):2345–2353. Available from: https://doi.org/10.1016/j.numecd.2021.04.016
Babiker A, Jeudy J, Kligerman S, Khambaty M, Shah A, Bagchi S. Risk of cardiovascular disease due to chronic hepatitis C infection: A review. J Clin Transl Hepatol. 2017;5(4):343–362. Available from: https://doi.org/10.14218/jcth.2017.00021
Cacoub P. Hepatitis C virus infection, a new modifiable cardiovascular risk factor. Gastroenterology. 2019;156(4):862–864. Available from: https://doi.org/10.1053/j.gastro.2019.02.009