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Hepatology
Increased cardiovascular risk and reduced quality of life are highly prevalent among individuals with hepatitis C
  1. Stuart McPherson1,2,
  2. Shion Gosrani1,
  3. Sarah Hogg1,
  4. Preya Patel1,
  5. Aaron Wetten1,
  6. Rachael Welton1,
  7. Kate Hallsworth1,2,
  8. Matthew Campbell3,4
  1. 1Liver Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  2. 2Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
  3. 3School of Food Science and Nutrition, University of Leeds, Leeds, West Yorkshire, UK
  4. 4Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
  1. Correspondence to Dr Stuart McPherson; stuart.mcpherson2{at}nhs.net

Abstract

Objective Hepatitis 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.

Design Cross-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.

Results 100 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.

Conclusion A 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.

  • HCV
  • quality of life
  • diabetes mellitus
  • obesity
  • cardiovascular disease
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgast-2020-000470

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    Footnotes

    • Twitter @stumcp

    • Contributors Study design and concept: SMcP, KH and MC; funding acquisition: SMcP and MC; data collection: SMcP, SG, SH and RW; data analysis: SMcP, PP, AW, KH and MC; writing and approval of the final manuscript: all authors; development of the care bundle; SMcP, KH, PP, AW and MC; guarantor SMcP.

    • Funding LIVErNORTH Charity.

    • Competing interests SMcP: consultancy/speakers fees from Abbvie, Allergan, BMS, Cambwick, Gilead, Intercept, MSD, Novartis and Sequana.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by North East–Tyne and Wear South Research Ethics Committee (16/NE/0239) and all participants provided written informed consent before enrolment.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Data are available on request from stuart.mcpherson2@nhs.net.