Increased cardiovascular risk and reduced quality of life are highly prevalent among individuals with hepatitis C

Abstract

ObjectiveHepatitis C virus (HCV) infection is common. Although treatment is effective, with oral antivirals curing >95% of patients, most individuals have comorbidities that persist long term. Therefore, our aim was to determine the prevalence of potentially modifiable health problems in patients with HCV and develop an HCV care bundle to identify and target comorbidities.DesignCross-sectional, observational single-centre study that recruited consecutive patients with HCV from our viral hepatitis clinics. Data were collected on cardiovascular (CV) risk factors, lifestyle behaviours, anthropometry and health-related quality of life (HRQoL). QRISK 3 was used to predict 10-year CV event risk.Results100 patients were recruited (67% male, 93% white, median age 52 years (range 24–80); 71% were treated for HCV; 34% had cirrhosis; 14% had diabetes; 61% had hypertension; 31% had metabolic syndrome; and 54% were smokers). The median 10-year CV event risk was 8.3% (range 0.3%–63%). 45% had a predicted 10-year CV event risk of >10%. Only 10% of individuals were treated with statins and 27% with antihypertensives. 92% had a predicted ‘heart age’ greater than their chronological age (median difference +7 (−4 to +26) years). HRQoL was reduced in all SF36v2 domains in the cohort. Factors independently associated with HRQoL included cirrhosis, metabolic syndrome, history of mental health disorder, sedentary behaviour and HCV viraemia.ConclusionA large proportion of patients with HCV presented with increased risk of CV events, and rates of smoking and sedentary behaviour were high, while prescribing of primary prophylaxis was infrequent. HRQoL was also reduced in the cohort. A ‘care bundle’ was developed to provide a structured approach to treating potentially modifiable health problems.

Association of exercise participation levels with cardiometabolic health and quality of life in individuals with hepatitis C

“…Our data support previous research highlighting patients with HCV have a significantly reduced HRQoL. 7 11 12 The present study extends this work, showing that patients with HCV who are regularly active report significantly higher HRQoL, across SF36v2 domains, compared with inactive counterparts. The main motivator for exercising was to improve physical performance, with those that exercised regularly indicating that improving muscle tone, stamina and cardiovascular fitness as being most important.…”

“…HRQoL was reduced with mean scores for all SF36v2 domains below that of the general population (data shown previously 7 ). However, patients categorised as active demonstrated significantly higher HRQoL scores (signifying better HRQoL) across SF36v2 domains, including: Physical Functioning (41±11 vs 48±11, p=0.031), General Health (37±11 vs 45±11, p=0.001), Vitality (39±10 vs 48±12, p<0.001), Social Functioning (35±14 vs 46±13, p=0.003), Mental Health (37±14 vs 48±11, p=0.003), Physical Component Score (41±12 vs 47±10, p=0.003), Mental Component Score (36±15 vs 46±33, p=0.003), Hepatitis Distress (42±33 vs 65±33, p=0.005), Physical Wellbeing (40±28 vs 64±23, p=0.017), for inactive versus active individuals, respectively.…”

“…The clinical picture of HCV and recovery from treatment is characterised by a highly comorbid state coupled with reduced life expectancy. We have previously shown a high prevalence of cardiometabolic risk in this cohort of patients with HCV, 7 however, the finding that increased cardiometabolic risk is ubiquitous within this patient group irrespective of PA/exercise participation was somewhat unexpected. Participation in regular PA/exercise is widely recognised to reduce cardiometabolic risks in both the general population and those with chronic disease.…”

“…This cross-sectional, observational study recruited consecutive patients with HCV (treated or untreated) attending the viral hepatitis clinics at The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. This was a substudy of the previously reported ENHANCE study 7 and included 86 patients (out of 100) who had complete EBBS data. Unfortunately, 14 of the patients did not complete the EBBS survey or did not complete is fully so were excluded from the analysis.…”

“…Hepatitis C virus (HCV) infection is a major cause of chronic liver disease affecting an estimated 71 million people worldwide. 1 The disease causes numerous extrahepatic manifestations resulting in a high burden of comorbidity, including increased risk of cardiovascular disease (CVD) [2][3][4][5][6][7] and neuropsychiatric disorders and depression [8][9][10] even after successful antiviral treatment. Healthrelated quality of life (HRQoL) is also significantly reduced compared with non-HCV infected individuals.…”