Published online Apr 7, 2014. doi: 10.3748/wjg.v20.i13.3410
Revised: October 30, 2013
Accepted: January 6, 2014
Published online: April 7, 2014
Hepatitis C virus (HCV) infection represents a major health issue worldwide due to its burden of chronic liver disease and extrahepatic manifestations including cardiovascular diseases, which are associated with excess mortality. Analysis of published studies supports the view that HCV infection should be considered a risk factor for the development of carotid atherosclerosis, heart failure and stroke. In contrast, findings from studies addressing coronary artery disease and HCV have yielded conflicting results. Therefore, meta-analytic reviews and prospective studies are warranted. The pathogenic mechanisms connecting HCV infection, chronic liver disease, and atherogenesis are not completely understood. However, it has been hypothesized that HCV may promote atherogenesis and its complications through several direct and indirect biological mechanisms involving HCV colonization and replication within arterial walls, liver steatosis and fibrosis, enhanced and imbalanced secretion of inflammatory cytokines, oxidative stress, endotoxemia, mixed cryoglobulinemia, perturbed cellular and humoral immunity, hyperhomocysteinemia, hypo-adiponectinaemia, insulin resistance, type 2 diabetes and other components of the metabolic syndrome. Understanding these complex mechanisms is of fundamental importance for the development of novel therapeutic approaches to prevent and to treat vascular complications in patients with chronic HCV infection. Currently, it seems that HCV clearance by interferon and ribavirin treatment significantly reduces non-liver-related mortality; moreover, interferon-based treatment appears to decrease the risk of ischemic stroke.
Core tip: Hepatitis C virus (HCV) infection represents a risk factor for carotid atherosclerosis, heart failure and ischemic stroke. However, findings from studies addressing coronary artery disease and HCV have yielded conflicting results. Moreover, an excess of cardiovascular mortality among anti-HCV positive subjects has been reported. HCV promotes atherogenesis through direct and indirect mechanisms. Inflammation, cytokines activation, cellular and humoral immunity, metabolic derangement, oxidative stress, liver steatosis and fibrosis have been postulated as potential atherogenic mechanisms. Knowledge of such complex mechanisms may be important for understanding disease progression and promoting novel therapeutic approaches. At present, interferon-based treatment of chronic hepatitis C seems to reduce the risk of stroke as well as non-liver-related mortality.