This is from January 2016 but well worth the reprint.  We are noting more and more people being cured of HCV only to have heart attacks and strokes.  Further, some studies have shown that some DAAs affect LDL levels (bad cholesterol) such that for 6-months post treatment LDL levels can be higher than normal and this is a stroke risk.  Studies from Japan and Egypt have noted that sofosbuvir-containing treatments may have caused strokes – CDM.

People with hepatitis C are at higher risk of dying from cardiovascular disease, having a stroke, or developing other cardiovascular problems than people with similar risk factors for heart disease who do not have hepatitis C, a meta-analysis of published studies has shown. The findings, published in the January 2016 edition of Gastroenterology, come from a meta-analysis of 22 epidemiological studies conducted in Italy.

The impact of hepatitis C on the incidence of cardiovascular events, including stroke, was calculated from 8 studies, combining data from 390,602 people who experienced 18,388 events. Hepatitis C increased the risk of any event modestly, by 30% (odds ratio 1.30; p=0.002), and the effect was similar – a 35% increase – when the analysis was confined to stroke alone (odds ratio 1.30; p=0.05). The risk was significantly higher in studies where the background rate of diabetes was above 10%, the prevalence of high blood pressure was above 20%, or the average age of the study population was above 50 years.

The authors note that even after allowing for the well-established risk factors for heart disease – diabetes, high blood pressure, and smoking – the risk of death, cardiovascular disease, and carotid artery disease was still elevated in people with hepatitis C. Indeed, they describe the effect of hepatitis C on cardiovascular risk as “especially pronounced” in populations where diabetes, high blood pressure, or smoking are common.

The authors suggest that the metabolic abnormalities common in people with hepatitis C may provide one explanation for the increased risk, but they also point to recent evidence showing that hepatitis C promotes inflammation, which contributes to the development of cardiovascular disease.

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