Affairs of the Heart

Studies show HCV infection could increase heart disease risk

by Larry Buhl

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[dropcap]It[/dropcap] is well known that people with hepatitis C virus (HCV) are at risk for liver damage, but the results of two new studies suggest that chronic HCV infection could lead to heart problems as well.

Researchers of one of those studies, conducted out of Johns Hopkins University and published online July 27 in The Journal of Infectious Diseases, offer big caveats. Their study sample was small and was cross-sectional, looking at one point in time. However the result adds to a growing pool of evidence suggesting that HCV does damage to the body beyond destroying the liver.

The Johns Hopkins researchers previously studied 1,000 people with HIV and found that virus to be associated with artery-clogging plaque, the main driver of heart attack and stroke risk.

The study involved 994 men between forty and seventy years-old across several medical institutions in Baltimore, Washington, D.C., Pittsburgh, Los Angeles, and Chicago. Of that group, 613 were infected with HIV, seventy were infected with both HIV and hepatitis C, and seventeen were only infected with hepatitis C.

Cardiac CT scans were conducted on those who had either HCV, HIV, or both viruses to measure the amount of fat and calcium deposits inside the vessels of their hearts. Those infected with hep C, regardless of HIV status, had thirty percent more calcified plaque in their arteries. People infected with either HIV or hepatitis C, on average, had forty-two percent more non-calcified fatty buildup, a type of plaque that’s thought to present the greatest risk of heart conditions.

In addition, those who had higher levels of circulating hepatitis C virus in their blood were fifty percent more likely to have clogged arteries, compared with men without hepatitis C.

“Some studies say there is a strong HIV/HCV synergy, but in this study we were surprised to find that the plaque associated with HCV was not influenced by having HIV, and vice versa,” said the study’s principal investigator Eric Seaberg, PhD, assistant professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.

Seaberg and colleagues also found that the potential heart risk of having HCV was stratified by viral load. Those with a hepatitis viral load greater than 2 million had a much higher level of calcified and non-calcified plaque. Non-calcified plaque, Seaberg points out, is actually more dangerous because of its instability and likelihood to move around the arteries.

Another recent study revealed at the International Liver Congress in April, also showed that chronic hepatitis C virus (HCV) infection is associated with a higher risk of developing cardiovascular diseases and significantly increases cost of care and length of time in hospital.

In this larger retrospective analysis, Howard University professors Dr. Firew Wubiee and Dr. Charles Howell and their team analyzed more than 200,000 inpatients with and without HCV infection at discharge using data obtained from the 2011 Nationwide Inpatient Sample, an all-payer inpatient care database containing information on more than 7 million hospital stays in the U.S.

They found that those with HCV were twenty-nine percent more likely to have had an acute myocardial infarction (heart attack), ninety-eight percent more likely to have experienced a cerebral vascular “accident” (such as a stroke or cerebral hemmorhage) and eighty-eight percent times more likely to have coronary artery disease. There was also an eight percent increased risk for heart failure.

Based on these results, study investigators conclude that chronic HCV infection should be considered a risk factor for the development of cardiovascular diseases.

Seaberg tells A&U that, because the Johns Hopkins cross-sectional study was so small, he is hesitant to make a pronouncement on causation, but he says the findings could mean that higher levels of HCV drive inflammation throughout the body. And inflammation can accelerate blood vessel damage that may contribute to heart disease.

Seaberg adds that more information on the HCV/heart risk may come after he finishes a longitudinal study to see the progression of heart disease of men with hepatitis C over the course of three years.

Subsequent studies are also needed to help doctors understand is whether the new class of HCV meds might stop the formation of plaque and reduce cardiac risk for their patients who have the virus.

The Johns Hopkins researchers say that, until more studies are done, it would be prudent for patients with hepatitis C to have an annual cardiac evaluation, which should include cholesterol and glucose testing, a blood pressure check and a thorough assessment of lifestyle habits that could lead to or exacerbate heart problems.


 

Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles. His podcast on employment issues, “Labor Pains,” can be found at www.laborpainspodcast.com.