The relation between hepatitis C virus and coronary heart disease

It is well known that chronic hepatitis C is associated with insulin resistance and metabolic syndrome which are risk factors for atherosclerosis and coronary heart disease. As a result, chronic hepatitis C might be thought, through its association with metabolic syndrome, to increase the risk of myocardial infarction. However, unexpectedly it was found that HCV infection is not associated with an increased risk of myocardial infarction. We are providing here an hypothesis of the mechanism through which HCV infection does not increase the risk for myocardial infarction and also may be protecting against some cardiovascular risks that typically develop in many patients with metabolic syndrome who do not have chronic hepatitis C. The suggested mechanism includes factors that are normal consequences of chronic hepatitis, such as: significant decrease in cholesterol and LDL levels; defected blood clotting system; impaired myocardial function; decreased venous return and central venous pressure; increased nitric oxide and TNF alpha levels; and diminished cardiac beta receptors signal transduction. All these factors contribute to a protective effect against cardiac ischemia and coronary heart disease. We suggest further studies to investigate this hypothesis. (C) 2014 Elsevier Ltd. All rights reserved.