Carotid atherosclerosis and chronic hepatitis C: A prospective study of risk associations.

BACKGROUND AND AIMS: There are contrasting results in studies of cardiovascular risk in patients with genotype 1 chronic hepatitis C (G1 CHC). We evaluated the prevalence of carotid atherosclerosis compared with a control population in order to assess the potential association between atherosclerosis, host and viral factors, and liver histological features. MATERIALS AND METHODS: One hundred seventy-four consecutive biopsy-proven G1 CHC patients were evaluated by anthropometric and metabolic measurements. One hundred seventy-four patients attending an outpatient cardiology unit were used as controls. Intima-media thickness (IMT) and carotid plaques, defined as focal thickening of > 1.3 mm at the level of common carotid, were evaluated using ultrasonography. All G1 CHC biopsies were scored by one pathologist for staging and grading, and graded for steatosis. RESULTS: Carotid plaques were found in 73 (41.9%) G1 CHC patients compared with 40 (22.9%) control patients (p<0.001). Similarly, G1 CHC patients had a greater IMT compared with control patients (1.04±0.21 versus 0.90±0.16; p<0.001). Multivariate logistic regression analysis showed that older age (OR 1.047, 95%CI 1.014-1.082, p= 0.005), and severe hepatic fibrosis (OR 2.177, 95%CI 1.043-4.542, p=0.03), were independently linked to the presence of carotid plaques. In patients aged ≤55 years, 15/67 cases with F0-F2 fibrosis (22.3%) had carotid plaques, compared with 11/21 (52.3%) with F3-F4 fibrosis (p=0.008). By contrast, in patients >55 years the prevalence of carotid plaques was similar in those with or without severe fibrosis (25/43, 58.1% versus 22/43, 51.1%; p=0.51). CONCLUSION: Severe hepatic fibrosis is associated with a high risk of early carotid atherosclerosis in G1 CHC patients.