Hepatitis C virus infection and atherosclerotic cardiovascular disease: recent knowledge, further insights

Dear Editor,
We have recently read with great interest the elegant paper authored by Piekarska et al. [1], who presented the results of the PRO-CARDIO-C study. The authors demonstrated in their large cohort that the relative frequency of positive anti-HCV (hepatitis C virus) antibodies and detectable HCV RNA in patients with coronary artery disease was not significantly different compared to that observed in patients hospitalized in a Dermatology Department (controls), despite the fact that the prevalence of chronic HCV infection was 5-fold higher compared to the general population [1].
Recently, Wen et al. published the results of their meta-analysis, demonstrating that HCV infection increases the risk of coronary artery disease (CAD) by 25% [risk ratio (RR): 1.25, 95% CI: 1.12-1.40] in cohort studies and the odds for CAD by 94% [odds ratio (OR): 1.58-2.38] in case-control and cross-sectional studies, establishing this close relationship [2]. Similar results were obtained by another meta-analysis in a total of 297,613 patients, confirming the association between HCV infection and cardio-cerebrovascular disease and its related mortality [3]. In a recent 13-year nationwide population-based study in Asia enrolling 31,943 patients either with chronic HBV (hepatitis B virus) or HCV infection it was shown that patients with HCV infection exhibit 38% greater risk of acute coronary syndrome (ACS) [hazard ratio (HR): 1.38, 95% CI: 1.02-1.85], compared to HCV patients, while they also exhibited a significant increase in the risk of all-cause mortality by 48%, acute ischemic stroke by 38% and composite arterial events (ACS, acute ischemic stroke, peripheral artery disease) by 29% [4]. However, data are contradictory concerning the angiographically proven atherosclerotic burden of CAD in patients with HCV infection compared to HCV negative control subjects [5, 6].
Thus, it seems undeniable that chronic HCV infection boosts the cardiovascular disease burden among the affected patients. The role of co-morbidities is of utmost importance, as it was recently observed in a US population-based study [7]. It would be interesting if Piekarska et al. could provide us with the patients’ co-morbidities, mainly diabetes mellitus, chronic kidney disease, hypertension and obesity, as they might have an impact on their results [1]. Another recently published retrospective analysis demonstrated that the presence of hepatic steatosis in a large cohort of patients...


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