title: Chronic HCV infection is a risk of atherosclerosis. Role of HCV and HCV-related steatosis.
abstract: OBJECTIVE
  HCV and NAFLD are associated with atherosclerosis in general population. The prevalence of atherosclerosis in chronic hepatitis C (CHC) patients is unknown. We hypothesized that HCV per se and HCV-related steatosis could favour atherosclerosis. Thus, in CHC patients we assessed: (a) the prevalence of atherosclerosis; (b) the role of HCV, cardio-metabolic risk factors and hepatic histology.
  
  
  METHODS
  Overall, 803 subjects were enrolled: (A) 326 patients with liver biopsy-proven treatment naive CHC (175 with and 151 without steatosis); (B) 477 age and gender matched controls, including 292 healthy subjects without steatosis (B1) and 185 with NAFLD (B2). Carotid atherosclerosis (CA), assessed by high-resolution B-mode ultrasonography, was categorized as either intima-media thickness (IMT: >1mm) or plaques (≥ 1.5mm).
  
  
  RESULTS
  CHC patients had a higher prevalence of CA than controls (53.7% vs 34.3%; p<0.0001). Younger CHC (<50 years) had a higher prevalence of CA than controls (34.0% vs 16.0%; p<0.04). CHC patients without steatosis had a higher prevalence of CA than B1 controls (26.0% vs 14.8%; p<0.02). CHC with steatosis had a higher prevalence of CA than NAFLD patients (77.7% vs 57.8%, p<0.0001). Viral load was associated with serum CRP and fibrinogen levels; steatosis with metabolic syndrome, HOMA-IR, hyperhomocysteinemia and liver fibrosis. Viral load and steatosis were independently associated with CA. Diabetes and metabolic syndrome were associated with plaques.
  
  
  CONCLUSIONS
  HCV infection is a risk factor for earlier and facilitated occurrence of CA via viral load and steatosis which modulate atherogenic factors such as inflammation and dysmetabolic milieu.
authors.affiliation: Internal Medicine and Hepatology, Second University of Naples, Italy. luigielio.adinolfi@unina2.it
authors.forename: Luigi E
authors.initials: LE
authors.lastname: Adinolfi
authors.forename: Luciano
authors.initials: L
authors.lastname: Restivo
authors.forename: Rosa
authors.initials: R
authors.lastname: Zampino
authors.forename: Barbara
authors.initials: B
authors.lastname: Guerrera
authors.forename: Amedeo
authors.initials: A
authors.lastname: Lonardo
authors.forename: Laura
authors.initials: L
authors.lastname: Ruggiero
authors.forename: Francesco
authors.initials: F
authors.lastname: Riello
authors.forename: Paola
authors.initials: P
authors.lastname: Loria
authors.forename: Anna
authors.initials: A
authors.lastname: Florio
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D005234:Fatty Liver / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D019562:Viral Load; D055815:Young Adult