Unit of Internal Medicine, Department of Advanced Medical and Surgery Sciences, Luigi Vanvitelli University of Campania, Naples, Italy.
Unit of Internal Medicine, Department of Advanced Medical and Surgery Sciences, Luigi Vanvitelli University of Campania, Naples, Italy -
Minerva Med. 2021 Apr;112(2):188-200. doi: 10.23736/S0026-4806.20.07129-3. Epub 2020 Nov 18.
Despite the availability of effective treatments, hepatitis C virus (HCV) still remains a threat to public health. HCV is capable to trigger, behind liver damage, extrahepatic manifestations, including cardiovascular disease and type 2 diabetes (T2DM). A close association has been reported between HCV infection and cardiovascular disease due to imbalances in metabolic pathways and chronic inflammation. HCV through both direct and indirect mechanisms causes a higher incidence of ischemic stroke, acute coronary syndrome, heart failure and peripheral arterial disease. In addition, a higher risk of death from cardiovascular events has been showed in HCV patients. Insulin resistance is a hallmark of HCV infection and represents the link between HCV and T2DM, which is one of the most frequent HCV-associated extrahepatic manifestations. The pathological basis of the increased risk of T2DM in HCV infection is provided by the alterations of the molecular mechanisms of IR induced both by the direct effects of the HCV proteins, and by the indirect effects mediated by chronic inflammation, oxidative stress and hepatic steatosis. T2DM increases the risk of compensated and decompensate cirrhosis and hepatocellular carcinoma as well as increases the risk of cardiovascular disease, lower limb amputation and end stage renal disease. Current evidence suggests that HCV eradication reduces the incidence and mortality of cardiovascular disease and T2DM, further underling the importance of public health strategies for eradication the infection. The aim of this review was to update evidence and management of interaction between HCV, cardiovascular disease, and T2DM in the era of DAA treatment.
尽管有有效的治疗方法，但丙型肝炎病毒 (HCV) 仍然对公共卫生构成威胁。HCV 能够在肝损伤的基础上引发肝外表现，包括心血管疾病和 2 型糖尿病 (T2DM)。由于代谢途径和慢性炎症的失衡，HCV 感染与心血管疾病之间存在密切关联。HCV 通过直接和间接机制导致缺血性中风、急性冠状动脉综合征、心力衰竭和外周动脉疾病的发生率更高。此外，HCV 患者心血管事件死亡的风险更高。胰岛素抵抗是 HCV 感染的标志，代表了 HCV 与 T2DM 之间的联系，T2DM 是 HCV 相关肝外表现中最常见的一种。HCV 感染中 T2DM 风险增加的病理基础是由 HCV 蛋白的直接作用以及慢性炎症、氧化应激和肝脂肪变性介导的间接作用引起的 IR 分子机制的改变提供的。T2DM 会增加代偿性和失代偿性肝硬化以及肝细胞癌的风险，并增加心血管疾病、下肢截肢和终末期肾病的风险。目前的证据表明，HCV 清除可降低心血管疾病和 T2DM 的发病率和死亡率，进一步强调了消除感染的公共卫生策略的重要性。本综述的目的是在 DAA 治疗时代更新 HCV、心血管疾病和 T2DM 之间相互作用的证据和管理。
