title: Chronic HCV infection is a risk factor of ischemic stroke.
abstract: OBJECTIVE
  Cerebrovascular diseases are leading cause of death worldwide. Plaque rupture and embolization account for one-third of ischemic stroke. The causes are not fully known, but inflammation plays a pathogenic role. Recently, HCV infection has been identify as risk of atherosclerosis. HCV replicates within carotid plaques and brain endothelia cells; moreover, HCV patients showed higher levels of inflammation. Thus, we hypothesized that subjects carrying HCV are at higher risk of stroke. Accordingly, we evaluated prevalence and role of HCV infection in patients with stroke.
  
  
  METHODS
  A priori sample size was calculated. Overall, 820 consecutive patients were enrolled, 123 with stroke and, as control, 697 age- and gender-matched (295 with COPD; 402 with diseases other than HCV-associated). Patients were evaluated for HCV and conventional risk of stroke.
  
  
  RESULTS
  Prevalence of HCV was higher in patients with stroke than that observed in control (26.8% vs. 6.6%, p = 0.0001). An analysis of stroke patients showed that those HCV positive were younger (p = 0.017) had lower serum levels of cholesterol (p = 0.001), triglycerides (p = 0.045), and higher serum levels of inflammation markers (ESR, p = 0.001; CRP, p = 0.0001; fibrinogen, p = 0.012). A multivariate analysis showed that HCV infection was an independent risk factor of stroke (O.R. 2.04, 95% C.I. 1.69-2.46; p = 0.0001). A secondary analysis showed that HCV patients had higher (p = 0.031) prevalence of past ischemic heart disease.
  
  
  CONCLUSIONS
  HCV infected patients are at higher and earlier risk of stroke. Inflammation is a key mediator. Clinicians in clinical practice and researchers in future trials should take into account these new findings.
authors.affiliation: Department of Medicine, Surgery, Neurology, Geriatric and Metabolic Diseases, Second University of Naples, Internal Medicine of Clinic Hospital of Marcianise, ASL Caserta, Italy. Electronic address: 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: Barbara
authors.initials: B
authors.lastname: Guerrera
authors.forename: Ausilio
authors.initials: A
authors.lastname: Sellitto
authors.forename: Antonella
authors.initials: A
authors.lastname: Ciervo
authors.forename: Natalina
authors.initials: N
authors.lastname: Iuliano
authors.forename: Luca
authors.initials: L
authors.lastname: Rinaldi
authors.forename: Aldo
authors.initials: A
authors.lastname: Santoro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Li Vigni
authors.forename: Aldo
authors.initials: A
authors.lastname: Marrone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000821:virology
keywords: Atherosclerosis; HCV; Ischemic heart disease; Ischemic stroke