Abstract

Abstract
Background Chronic hepatitis C virus infection (CHC) is a risk factor for cardiovascular (CV) disease. Despite this, many clinicians focus on managing the hepatic complications of CHC and CV risk factors may not be assessed. Our aim was to examine the prevalence of CV risk factors in a cohort of CHC patients to determine the proportion of individuals at high risk of CV events and whether this risk was actively managed.

Methods Patients with CHC (untreated or cured) were recruited prospectively from viral hepatitis clinics. Data was collected on CV risk factors, lifestyle behaviours, anthropometry, and body composition. QRISK3, a validated tool to predict 10-year risk of CV events, was calculated.

Results 100 patients were recruited (67% male, 93% white, median age 52 years [range 24–80], 71% treated HCV, 34% advanced fibrosis/cirrhosis). Overall, the mean BMI was 28±6 kg/m2, 14% had type 2 diabetes, 61% had hypertension and 30% had the metabolic syndrome (ATPIII criteria). The median fat mass was 29% [7–45] for males and 39% [12–54] for females. 79% had a history of smoking and 52% were current smokers (UK average 15%). 9% of patients had diagnosed CV disease. Overall, the median 10-year CV event risk was 8.3% (0.3–63%). 45% had a predicted 10-year CV event risk of >10%, of which all were aged over 45 years. Despite presenting with a CV event risk indicative of statin treatment, only 10% of these individuals were treated with lipid lowering drugs and 27% treated with antihypertensives. Overall, 92% had a predicted ‘heart age’ greater than their actual age (median difference +7 [-4 to +26] years). There was no significant difference between predicted ‘heart age’ and actual age for treated CHC and those with active CHC (p=0.92)

Conclusions A large proportion of individuals with CHC attending secondary care clinics have a high risk of CV events and present with a range of comorbidities. In order to improve the holistic management of these patients, regular assessment of CV risk should be undertaken, particularly in those over 45 years. CV risk factors (smoking, BP, dyslipidaemia and diabetes) should be actively managed.