Research ArticleEffects of chronic hepatitis C infection on arterial stiffness
Introduction
Hepatitis C virus (HCV) infection has been reported to be associated with cardiovascular diseases, including coronary atherosclerosis,1, 2 heart failure,3 and carotid atherosclerosis.4, 5 However, it is unclear if HCV infection has an effect on arterial stiffness in hemodialysis patients.6, 7 It is also not clear whether HCV antibody seropositivity alone—regardless of HCV-RNA positivity—is associated with arterial stiffness. Nonalcoholic fatty liver disease (NAFLD) is one of the most frequently diagnosed chronic liver diseases among adults worldwide.8, 9 NAFLD has been shown to be significantly associated with an increased risk of cardiovascular disease,10 and some studies have indicated that NAFLD may be not only a marker but also an early mediator of arterial stiffness.11, 12, 13
We previously developed a novel Compliance Index (CI), derived from a dual-channel photoplethysmography system, to measure the relationship between volume and pressure changes in the fingertips; our data suggested that CI may be clinically useful for evaluating peripheral arterial stiffness.14, 15, 16, 17 Brachial–ankle pulse wave velocity (PWV)18 and carotid-radial PWV19 have also been used as surrogates of peripheral arterial stiffness. Stiffness Index (SI), derived from the digital volume pulse (DVP) measured by photoplethysmography, is an index of wave reflections and an acceptable marker of central arterial stiffness.20 Although carotid-femoral PWV is considered to be the gold standard measurement for aortic stiffness,21 different measurement tools and stiffness indices may reflect different clinical conditions. Our previous study has shown that peripheral arterial stiffness index changed more prominently than central index in metabolic disorder.17 Different results of previous studies for association between arterial stiffness and HCV infection are possible due to different measurements of central or peripheral arterial stiffness. Nowadays, there is little studies discussing the effects of chronic HCV infection on different arterial stiffness indices, such as peripheral (CI) or central (SI) arterial stiffness index.
We hypothesized that both chronic HCV infection and NAFLD may be associated with increased arterial stiffness. Understanding the mechanisms underlying this association is clinically important in devising preventive and therapeutic strategies for cardiovascular diseases. Indeed, the impact of NAFLD and chronic viral hepatitis on risk of cardiovascular disease may have important implications for screening/surveillance strategies for this group of patients.
We previously demonstrated an association between decreased CI and increased SI in subjects with NAFLD.16 To our knowledge, there are no studies comparing peripheral arterial stiffness index, CI, or central arterial stiffness index, SI, two reliable indices of early atherosclerosis, in patients with NAFLD and chronic HCV infection. The principal aim of this cross-sectional study was to compare CI and SI in patients with NAFLD and chronic HCV infection. We also aimed to identify possible mechanism(s) underlying this association.
Section snippets
Study Population
This study enrolled 32 control subjects, 72 patients with NAFLD, and 117 patients with chronic HCV infection, who were evaluated by liver ultrasonography between February 2010 and February 2014. All patients underwent a routine check-up and health examination.
Patients were subjected to a thorough laboratory investigation for infection, autoimmune hepatitis, genetic disease, drugs, alcohol, and occupational exposure to exclude other causes of liver disease. Patients with clinical or biochemical
Clinical Characteristics of Each Patient Group
This study recruited a total of 221 patients including 32 patients without fatty liver or HCV infection (14 men, age 42 ± 12 years), 72 patients with NAFLD but no HCV infection (47 men, age 44 ± 11 years), and 117 patients with HCV infection (54 men, age 52 ± 8 years). Forty-four (37.6%) of enrolled 117 HCV patients also had NAFLD. Patients with NAFLD as well as those with HCV had significantly higher BMI, waist circumference, and mean blood pressure compared with the normal controls (NC) group
Major Findings
In the present study, we showed that patients in the HCV groups had significantly stiffer arteries (indicated by lower CI and higher SI) compared with the NC group. Chronic HCV infection was independently associated with arterial stiffness: only peripheral arterial stiffness index (CI) but not central arterial stiffness index (SI). Patients in the NAFLD and HCV groups also had more severe inflammation (indicated by significantly higher levels of log hsCRP) compared with the NC group. The
References (32)
- et al.
Association of hepatitis C virus seropositivity with inflammatory markers and heart failure in persons with coronary heart disease: data from the Heart and Soul study
J Card Fail
(2009) - et al.
Chronic HCV infection is a risk of atherosclerosis. Role of HCV and HCV-related steatosis
Atherosclerosis
(2012) - et al.
Differences and similarities in early atherosclerosis between patients with non-alcoholic steatohepatitis and chronic hepatitis B and C
J Hepatol
(2007) - et al.
Nonalcoholic steatohepatitis: what we know in the new millennium
Am J Gastroenterol
(2002) - et al.
Effects of increased systemic inflammation and central obesity on arterial stiffness in patients with nonalcoholic fatty liver disease
J Am Soc Hypertens
(2012) - et al.
Low serum adiponectin level is associated with metabolic syndrome and is an independent marker of peripheral arterial stiffness in hypertensive patients
Diabetol Metab Syndr
(2017) - et al.
Peripheral arterial stiffness is associated with higher baseline plasma uric acid: a prospective cohort study
Saudi J Biol Sci
(2017) - et al.
The use of ultrasound to diagnose hepatic steatosis in type 2 diabetes: intra- and interobserver variability and comparison with magnetic resonance spectroscopy
Clin Radiol
(2011) - et al.
Hepatitis C virus seropositivity, but not hepatitis B virus carrier or seropositivity, associated with increased pulse wave velocity
Atherosclerosis
(2003) - et al.
Insulin-resistance HCV infection-related affects vascular stiffness in normotensives
Atherosclerosis
(2015)
Identification of the hemoglobin scavenger receptor/CD163 as a natural soluble protein in plasma
Blood
The monocytic lineage specific soluble CD163 is a plasma marker of coronary atherosclerosis
Atherosclerosis
Aortic stiffness: current understanding and future directions
J Am Coll Cardiol
Hepatitis C infection is associated with increased coronary artery atherosclerosis defined by modified Reardon severity score system
Circ J
Hepatitis C virus infection and the risk of coronary disease
Clin Infect Dis
What factors accelerate aortic stiffening in hemodialysis patients? An observational study
Hypertens Res
Cited by (9)
Different effects of apnea during rapid eye movement period on peripheral arterial stiffness in obstructive sleep apnea
2018, AtherosclerosisCitation Excerpt :It is caused by structural changes in the vascular wall, including fibrosis, medial smooth muscle cell necrosis, breaks in elastin fibers, calcifications, and diffusion of macromolecules into the arterial wall [11,12]. Arterial stiffness can be measured by several indices that are obtained in different arterial territories, such as central portions (carotid–femoral pulse wave velocity [PWVcf]; digital volume pulse–derived pulse wave velocity [PWVDVP]; cardio–ankle vascular index [CAVI]) [9,13,14] and peripheral portions (carotid–radial pulse wave velocity [PWVcr]; compliance index [CI]) [2,10,15,16]. We have demonstrated that there is a good correlation (r = 0.669, p < 0.001) between PWVDVP and PWVcf in 100 asymptomatic hospital staff members [13].
Interleukin-6-174G/C polymorphism is associated with a decreased risk of type 2 diabetes in patients with chronic hepatitis C virus
2020, World Journal of Hepatology
Conflict-of-interest: none.
- 1
These authors contributed to this article equally.