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HCV eradication with DAAs improves carotid thickening

Hepatitis C eradication by direct-acting antivirals improved carotid atherosclerosis in patients with severe fibrosis regardless of the presence of additional metabolic risk factors, according to recently published data.

“Emerging data ... support a link between HCV infection and cardiovascular alterations,” Salvatore Petta, MD, PhD, from the Università di Palermo, Italy, and colleagues wrote. “In our cohort of HCV patients with severe fibrosis and, in two-thirds of cases, compensated cirrhosis, HCV eradication by DAA improved carotid atherosclerosis in terms of reduction of both [intima-media thickness (IMT)] and carotid thickening.”

The study comprised 182 patients with advanced chronic HCV or compensated cirrhosis due to HCV who underwent DAA therapy. As controls, Petta and colleagues reviewed data of 76 patients with HCV who previously underwent observation for atherosclerosis progression and had not undergone DAA therapy.

“Concerning this topic, available results on cohorts of patients who underwent [interferon]-based therapies are very controversial, ranging from no impact of liver fibrosis to an improvement in cardiometabolic prognosis, to a more pronounced effect in patients with mild disease or in patients with advanced fibrosis/cirrhosis,” Petta and colleagues wrote.

Among the study cohort, 14% were obese, 41.8% had hypertension, 20% had diabetes and 42.9% had carotid thickening and carotid plaques. Mean IMT was 0.94 mm.

The researchers observed that older age was independently linked with carotid thickening (OR = 1.07; 95% CI, 1.03-1.1) and both older age (OR = 1.04; 95% CI, 1.01-1.08) and lower platelets (OR = 1; 95% CI, 1-1.01) were risk factors for carotid plaques.

From baseline to follow-up at 9 months to 12 months, mean IMT decreased significantly after patients achieved sustained virologic response with DAA therapy (0.94 vs. 0.81 mm; P < .001). The researchers also observed a significant reduction in the proportion of patients with carotid thickening (42.8% vs 17%; P < .001).

Blood glucose levels improved in both patients with (134.7 vs. 90.7; P < .001) and without (95.7 vs. 88.6; P < .001) diabetes. Some patients with diabetes achieved a reduced need for insulin or oral antidiabetic drugs.

In a subgroup analysis, the researchers found that IMT and carotid thickening (IMT ≥ 1 mm) improved significantly in patients younger than 65 years (P = .001) and those older than 65 years (P < .001), patients without obesity (P < .001), both smokers (P = .003) and nonsmokers (P < .001), patients with (P = .007) and without diabetes (P < .001), patients with (P = .002) and without hypertension (P < .001), and patients with (P = .03) and without hypercholesterolemia (P < .001).

“We found that SVR by DAA leads to reduction in IMT and in the prevalence of patients with carotid thickening at risk for cerebro-cardiovascular events, while no changes were observed in untreated patients,” the researchers concluded. “We also found that the effect of SVR on carotid atherosclerosis was maintained independently of the severity of liver damage — cirrhosis vs. advanced fibrosis and lower vs. higher platelet values.” – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.