Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 0954-691X Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MEG.0000000000001429 Original article 1432 Arterial wall structural changes in noncirrhotic chronic hepatitis C patients Hamdy A. Sliem a , Ahmed S. Salem b , Walid M. Hussien c and Hind R.A. El Sayed d Introduction Hepatitis C virus (HCV) infection is serious worldwide health’ threat. It is estimated that more than 180 million individuals are chronically infected worldwide. Patients with HCV infection may progress to hepatic and extra- hepatic complications. They may progress to cirrhosis and subsequently develop complications such as ascites, variceal bleeding, encephalopathy, and hepatocellular car- cinoma [1]. Records on the role of HCV in extrahepatic manifes- tations, including metabolic derangements, have surfaced, and more recently ones on accelerated clinical and sub- clinical atherosclerosis triggering ischemic heart disease have also been added [2]. The fact that traditional risk factors such as hyper- cholesterolemia, hypertension, and smoking cannot be used to explain the incidence of atherosclerosis in about 50% of the cases led to a search for additional putative risk factors involved in the development of the disease. The latest studies propose that certain chronic infections increase the risk of vascular diseases and such infections are considered modifable risk factors. Various microor- ganisms, particularly Chlamydia pneumonia, cytomegal- ovirus, Helicobacter pylori, and recently, HCV, may play a role in the etiological factors, linking infammation and atherogenesis pathogenesis [3]. Some preceding studies have found that chronic HCV infection is a probable risk factor for atherosclerosis, carotid artery plaques, and abnormal aortic elasticity, the development of cardiovascular disease, and signifcant morbidity and mortality. However, the exact mechanisms are still unclear [4]. Therefore, the assessment of the presence of subclinical or manifest vascular wall changes in HCV-infected patients is necessary. This is because of its prognostic value and its infuence on patient management. Discovery of such fac- tors along with their accompanying mechanisms of action would have profound implications for the development of new therapeutic strategies that would reduce the devastat- ing impact of this disease [5,6]. On the basis of these considerations, the current cross-sectional descriptive study was designed to investigate whether there was an association between noncirrhotic chronic HCV infection and subclinical arterial wall struc- tural changes [carotid artery intima-media thickness (IMT), aortic artery elasticity, stiffness, and dilatation], in addition to studying the impact of other cofactors such as viremia. Patients and methods A cross-sectional descriptive study was carried out in Suez Canal University Hospitals, Ismailia Hepatology Center, European Journal of Gastroenterology & Hepatology 2019, 31:1432–1438 Keywords: aortic stiffness, carotid intima thickness, hepatitis C Departments of a Internal Medicine, b Cardiology, c Diagnostic Radiology, Suez Canal University and d Ismailia Fever Hospital, Ismailia, Egypt Correspondence to Hamdy A. Sliem, MD, Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia 11431, Egypt Tel: +20 101 267 5260; fax 002027549755; e-mail: hamdy.sliem@yahoo.com Received 23 March 2019 Accepted 6 April 2019 Background Hepatitis C virus (HCV) infection is a major overall health predicament. Patients with HCV infection may progress to hepatic and extrahepatic complications. There are emerging groups of data on accelerated vascular changes triggering subclinical atherosclerosis. Nevertheless, whether these changes are associated with an increased risk of morbidity and mortality is unclear. Aim To determine subclinical arterial wall structural changes in noncirrhotic chronic hepatitis C patients and the impact of possible cofactors. Patients and methods Forty-two patients with noncirrhotic chronic HCV and 42 healthy controls matched in terms of age and sex were subjected to clinical, biochemical, and imaging measures for the evaluation of arterial wall changes (aortic elasticity/stiffness and carotid intima-media thickness). Elasticity was evaluated by measuring the aortic diameter and pulse wave velocity. Results Nonsignificant greater mean aortic diameter was found among the cases than the control group (P = 0.67). The mean carotid intima-media thickness was quite similar in both groups (P = 0.12). The mean pulse wave velocity measures were twice those in the cases than the control group, indicating greater tendencies toward arterial stiffness among patients with HCV (P < 0.001). There was no significant relationship between any of the laboratory investigations (lipid and HCV-RNA values) and any of the vascular imaging investigations. Conclusion Aortic diameter and aortic stiffness are increased among chronic hepatitis C patients than healthy controls; however, there is no significant difference in carotid intima thickness. Eur J Gastroenterol Hepatol 31: 1432–1438 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.