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A Confusing Relationship: Chronic Hep C and Cardiovascular Health

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Find out why a common indicator of cardiovascular disease is inaccurate for those with chronic Hepatitis C infection. February is American Heart Month.

People with chronic Hepatitis C infection are known to have an elevated risk for cardiovascular disease. Despite this understanding, the usual markers of cardiovascular disease may not necessarily apply to those with Hepatitis C. This is because the circulatory systems of people with Hepatitis C appear to contain less fat than the general population; however, there is sufficient evidence associating this chronic liver virus with atherosclerosis.

As if the Hepatitis C virus taking up residence in the liver isn’t enough to contend with, it also raises the risk for cardiovascular disease – the number one killer in America. Cardiovascular diseases are conditions that affect the heart and blood vessels, such as heart disease, high blood pressure, high cholesterol, deep vein thrombosis and stroke. Knowing the risks for cardiovascular disease can help people maintain their heart and blood vessel health, detect an emerging problem and successfully manage existing conditions.

The Usual Suspects

The primary cause of cardiovascular disease is atherosclerosis, otherwise known as hardening of the arteries. Atherosclerosis is a process in which deposits of fatty substances, cholesterol, cellular waste products, calcium and other substances build up in the inner lining of an artery. Called plaque, this buildup can grow large enough to significantly reduce the blood’s flow through an artery.

There is a long list of risks for developing atherosclerosis, including genetics, blood health markers, high blood pressure, other co-existing diseases, smoking, activity level, obesity and diet. However, hyperlipidemia is traditionally one of the most important risk factors for atherosclerosis. Hyperlipidemia is an elevation of lipids (fats) in the bloodstream. These lipids include cholesterol, cholesterol esters (compounds), phospholipids and triglycerides. Individuals who are considered to be at the highest risk for cardiovascular disease have atherosclerosis and hyperlipidemia.

The Confusion

The connection between hyperlipidemia and atherosclerosis is fairly straightforward and well understood by the healthcare community. However, their relationship is not linear in people with Hepatitis C. This is because research has found the following:

  • Hyperlipidemia – Published in the July 15, 2009 issue of Clinical Infectious Diseases, researchers from Pittsburgh, Pennsylvania conducted a large-scale study to evaluate the relationship between Hepatitis C and coronary artery disease. They found that those without Hepatitis C were dramatically more likely to have hyperlipidemia than those with Hepatitis C.
  • Atherosclerosis – On the other hand, a study described in a June 2010 advance online issue of Gut found that, despite the relative absence of hyperlipidemia, those with Hepatitis C had greater carotid intima-media thickness, an indicator of the early stages of atherosclerosis.

Because plaques in the arteries often consist of lipids, it is easy to see why hyperlipidemia is one of the leading causes of atherosclerosis. Based on the studies briefly described above (and several other confirming trials), Hepatitis C as a risk for cardiovascular disease does not follow this trend. Instead, the Hepatitis C virus demonstrates a lipid lowering action, while simultaneously causing a narrowing of the blood vessels. Experts assume that the virus likely initiates an inflammatory process that leads to atherosclerosis.

The reason those with Hepatitis C are more susceptible to cardiovascular disease is not because of hyperlipidemia. Thus, having healthy cholesterol and triglyceride levels in the presence of chronic Hepatitis C infection is not a permission slip to engage in activities that could further increase cardiovascular disease risk. As evidenced by atherosclerosis, Hepatitis C infection in and of itself – independent of blood lipids – automatically puts those infected in jeopardy. Therefore, individuals with Hepatitis C must make the effort to learn about their own cardiovascular health and take steps to protect their heart and blood vessels.


http://www.americanheart.org/presenter.jhtml?identifier=4440, Atherosclerosis, Retrieved August 12, 2010, American Heart Association, 2010.

http://www.americanheart.org/presenter.jhtml?identifier=4600, Hyperlipidemia, Retrieved August 12, 2010, American Heart Association, 2010.

http://www.everydayhealth.com/heart-health/index.aspx, Cardiovascular Health Center, Retrieved August 13, 2010, Everyday Health, Inc., 2010.

http://www.hepatitis-central.com/mt/archives/2010/02/hepatitis_c_is.html, Hepatitis C Is a Risk Factor for Heart Disease, Nicole Cutler, L.Ac., Retrieved August 10, 2010, Natural Wellness, 2010.

http://www.hivandhepatitis.com/hep_c/news/2010/011510_a.html, HCV Found in Carotid Atherosclerosis Plaques of Chronic Hepatitis C Patients, Liz Highleyman, Retrieved August 12, 2010, hivandhepatitis.com, 2010.

http://www.hivandhepatitis.com/hep_c/news/2010/0730_2010_a.html, Chronic Hepatitis C Virus Infection Is Associated with Early Atherosclerosis, Liz Highleyman, Retrieved August 10, 2010, hivandhepatitis.com, 2010.

http://www.ncbi.nlm.nih.gov/pubmed/15899668, Understanding hyperlipidemia and atherosclerosis: lessons from genetically modified apoe and ldlr mice, Wouters K, et al, Retrieved August 12, 2010, Clinical Chemistry and Laboratory Medicine, 2005.

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