title: The association between chronic hepatitis C infection and cardiovascular risk.
abstract: BACKGROUND
  Vascular disease is a common cause of death in patients with chronic hepatitis C (CHC) infection; however, the association between CHC and atherosclerosis is unclear.
  
  
  OBJECTIVE
  To determine whether patients with CHC have increased subclinical vascular disease and whether genotype or antiviral treatment modifies this risk.
  
  
  METHODS
  Fifty CHC patients and 22 age-matched and sex-matched healthy controls underwent clinical and biochemical assessment for vascular risk factors. In addition, vascular risk was assessed by measuring arterial stiffness (aortic augmentation index and carotid-femoral pulse wave velocity (PWV)), endothelial dysfunction (brachial artery flow-mediated dilatation (FMD) and dilatation post-glycerol trinitrate administration) and carotid intima-media thickness (CIMT). Assessment was repeated in subset of CHC patients (n = 12) undergoing antiviral treatment 18 months after initiation of treatment.
  
  
  RESULTS
  Baseline vascular risk factors and measures of arterial stiffness, endothelial dysfunction and CIMT were not different between cases and controls (P > 0.2 for all). Genotype 1 CHC patients had greater endothelial dysfunction with lower FMD (8.2 ± 3.5% vs 10.9 ± 5.2%, P = 0.03) and higher right CIMT (0.6 ± 0.1 mm vs 0.5 ± 0.07 mm, P = 0.04) compared with non-genotype 1. Patients who achieved sustained virological response (7/12) showed significant improvement in insulin resistance (homeostasis model of assessment of insulin resistance 2.3 ± 1.2 vs 1.8 ± 0.8, P = 0.02) and arterial stiffness (PWV 7.4 ± 1.1 m/s vs 6.5 ± 0.6 m/s, P = 0.04).
  
  
  CONCLUSIONS
  Subclinical vascular disease is not greater in CHC subjects compared with controls. However, among CHC subjects, genotype 1 infection is associated with greater endothelial dysfunction and increased carotid-intima medial thickness compared with non-genotype 1 infection. Successful viral eradication may improve insulin resistance and arterial stiffness.
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital.
authors.forename: P
authors.initials: P
authors.lastname: Pateria
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital.|School of Medicine and Pharmacology, University of Western Australia.
authors.forename: G P
authors.initials: GP
authors.lastname: Jeffrey
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital.|School of Medicine and Pharmacology, University of Western Australia.
authors.forename: G
authors.initials: G
authors.lastname: MacQuillan
authors.affiliation: PathWest Laboratory Medicine WA, Queen Elizabeth II Medical Centre.
authors.forename: D
authors.initials: D
authors.lastname: Speers
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital.|School of Medicine and Pharmacology, University of Western Australia.
authors.forename: H
authors.initials: H
authors.lastname: Ching
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital.
authors.forename: M A
authors.initials: MA
authors.lastname: Chinnaratha
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia.|Lipid Disorders Clinic, Cardiovascular Medicine, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: G F
authors.initials: GF
authors.lastname: Watts
authors.affiliation: Department of Gastroenterology and Hepatology, Sir Charles Gairdner Hospital.|School of Medicine and Pharmacology, University of Western Australia.
authors.forename: L A
authors.initials: LA
authors.lastname: Adams
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D059289:Vascular Stiffness / Q000502:physiology
keywords: atherosclerosis; carotid intima-media thickness; chronic hepatitis C; insulin resistance; pulse wave velocity