Cardiovascular events in chronic hepatitis C: prognostic value of liver stiffness evolution.
OBJECTIVE
Chronic hepatitis C is also a metabolic disease that may increase cardiovascular events. FibroScan is a diagnostic tool for fibrosis and a prognostic tool for cirrhosis complications and mortality. The aim of our study was to investigate the prognostic value of liver stiffness evolution and initial stiffness in cardiovascular events occurring in patients with chronic hepatitis C.


METHODS
Between 2006 and 2013, chronic hepatitis C patients followed in a reference center with two valid liver stiffness measurements by FibroScan were included. Cardiovascular events occurring after the initial FibroScan were collected retrospectively. 'Rapid stiffness progression' was defined as an evolution of at least 0.3 kPa/year and 'high initial stiffness' as at least 7 kPa.


RESULTS
Among 561 patients with chronic hepatitis C, 135 were included, mean follow-up 5.2 years, 56% men, mean age 55.3 years, infected with genotype 1 (71%). Among these, 27 were overweight, 12 had type 2 diabetes, 41 had steatosis, and 89 had been treated. During follow-up, seven patients had a cardiovascular event (four myocardial infarctions, three strokes). Among the 35 patients with rapid stiffness progression, 6% had a cardiovascular event compared with 5% of 100 patients with slow progression (P=1.0). Among the 57 patients with high initial stiffness, 11% had a cardiovascular event compared with 1% of the 78 patients with low initial stiffness (P=0.04).


CONCLUSIONS
In chronic hepatitis C, initial stiffness of at least 7 kPa was associated with cardiovascular events. Rapid progression of liver stiffness does not seem to be associated with these events.
aHepatology and Gastroenterology Unit, University Hospital bLaboratoire Inflammation, Tissus Epithéliaux et Cytokines, Pôle Biologie Santé, Poitiers University, Poitiers, France.
Laura
L
Serres
Philippe
P
Vasseur
David
D
Tougeron
Elise
E
Gand
Carine
C
Chagneau-Derrode
Florian
F
Charier
Sophie
S
Rochd
Christine
C
Silvain
D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000503:physiopathology* / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D050177:Overweight / Q000150:complications; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology*