Improvement of carotid atherosclerosis and peripheral artery disease after hepatitis C virus eradication by direct-acting antivirals

Abstract

Introduction: Recent research points to a link between chronic hepatitis C virus (HCV) infection and cardiovascular disease, especially carotid atherosclerosis, and suggests that HCV clearance may impact cardiovascular outcomes.

Aim: To determine if viral eradication by the new oral direct-acting antiviral (DAA) agents has benefit regarding carotid atherosclerosis, peripheral artery disease (PAD), steatosis, and liver fibrosis.

Patients, materials and methods: We conducted a prospective study on 168 patients diagnosed with chronic HCV infection or HCV-related cirrhosis. They were all treated with DAAs, with sustained virological response (SVR). Laboratory data, vibration-controlled transient elastography (VCTE), carotid intima-media thickness (IMT) measurement, and ankle-brachial index (ABI) were recorded in all patients.

Results: We found an average IMT of 1.22±0.2 mm, with a variance range from 1.14±0.19 mm in the mild and moderate fibrosis (≤F2) group to 1.29±0.25 mm in the severe fibrosis (≥F3) group. Also, patients with severe fibrosis (≥F3) present a more critical decrease of IMT values, with the carotid thickness affecting only 18.2% of individuals in the follow-up period. At the baseline, the best values of ABI were recorded in patients having F1-F2 fibrosis stage (mean value 1.02±0.19). Instead, in the group with severe fibrosis, the average value of ABI was lower (0.91±0.16) at the baseline, with a significant increase at SVR evaluation (p<0.001).

Conclusions: Our research highlights the beneficial effect of viral eradication on both carotid atherosclerosis and PAD, especially in those with advanced fibrosis and cirrhosis.

Figure 1

The atherosclerotic plaque and ultrasound measurement

Figure 2

– Assessment of carotid IMT. Measurement of the IMT of the CCA by high-resolution B-mode ultrasonography. IMT was measured by an automatic function algorithm as represented by the yellow and pink lines (the green line in the lumen of the CCA represents the reference value for the arterial wall echo gradient calculations). The yellow arrows fence the IMT thickness. CCA: Common carotid artery; IMT: Intima–media thickness

Figure 3

The calculation of IMT. CCA: Common carotid artery; ECA: External carotid artery; ICA: Internal carotid artery; IMT: Intima–media thickness

Figure 4

Correlation between CAP score post-SVR evaluation and IMT (A), ABI (B). ABI: Ankle–brachial index; CAP: Controlled attenuation parameter; IMT: Intima–media thickness; SVR: Sustained virological response.

Figure 5

Correlation between LSM score post-SVR evaluation and IMT (A), ABI (B). ABI: Ankle–brachial index; LSM: Liver stiffness measurements; IMT: Intima–media thickness; SVR: Sustained virological response