Prevalence and treatment of hyperlipidemia in patients with chronic hepatitis C infection

Murthy et al.
European Journal of Gastroenterology & Hepatology • August 2009 • Volume 21 - Issue 8

Special Author Introduction
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Hepatitis C (HCV) is the most common blood borne infection in the United States.  In the NHANES (National Health And Nutrition Evaluation Study) survey done from 1999 to 2002, the prevalence of HCV was 1.6% and 80% of them had chronic active infection (1). History of injection drug use was the strongest risk factor in the survey.  Other risk factors include homo and bisexuality, multiple of sex partners, alcoholism and drug use, blood transfusion prior to 1992, military service, body piercing/tattoos. Worldwide, the prevalence of HCV is about 3%.

Increased prevalence of type 2 diabetes mellitus has been associated with HCV infection (2,3). It is common knowledge that diabetes mellitus leads to dyslipidemia. Diabetes mellitus is considered a 'cardiac equivalent' and treating dyslipidemia in this population and in persons with arterial disease is of paramount importance. Fatty liver changes do occur with HCV infection and in other liver diseases. These are independent of glucose intolerance that may develop in HCV infected persons.

In our study the prevalence of hyperlipidemia in patients infected with HCV was 70%. About half of these people are eligible for lowering cholesterol with medications.  23% of treatment eligible patients had compelling indications (diabetes mellitus, arterial disease or both) to lower their lipid levels. Treatment of hyperlipidemia is necessary and is feasible in patients infected with HCV. An understandable common fear is that lowering lipid levels with medications (e.g. statins) that have known hepatotoxic side effects would be expected to worsen hepatic function. In one study the investigators compared the effects of statins on transaminase levels in patients with and without hepatitis C and found no difference in the incidence of adverse hepatic events (4).  Another study showed improvement in ALT levels in patients with hepatitis C infection treated with atorvastatin.  A liver expert panel concluded that chronic liver disease is not a contraindication to statin therapy to lower lipid levels (5).

In conclusion, treating hyperlipidemia in patients infected with HCV is important and is quite feasible. Increasing awareness by providers of very low incidence of adverse effects of statins and other drugs should facilitate improved therapy of hyperlipidemia in patients with HCV infection and other liver diseases.

References:

1. Gregory L. Armstrong, MD; Annemarie Wasley, ScD et al. The Prevalence of hepatitis C Virus Infection in The United States, 1999 Through 2002.  Annals of Internal Medicine 2006; 144(10):705-14.
2. Antonelli A, Ferri C, Fallahi P, et al. Hepatitis C Virus Infection: Evidence for an association with type 2 diabetes. Diabetes Care 2005; 28(10):2548-50
3.Shintani Y, Fujie H, Miyoshi H, et al. Hepatitis virus C infection and diabetes: Direct involvement of the virus in the development of  insulin resistance. Gastroenterology 2004; 126:840.
4.Khorashadi S, Hasson NK, Cheung RC. What is The Risk of Developing Hepatotoxicity from Statin Therapy in Hyperlipidemic Patients with Hepatitis C? - Clin Gastroenterol Hepatol 2006; 4:902-7.