The effect of hepatitis C virologic clearance on cardiovascular disease biomarker lipoprotein-associated phospholipase A2 and its relation to serum lipids

Background: Chronic hepatitis C virus (HCV) infection has been linked to cardiovascular disease (CVD). However, CVD risk prediction in chronic HCV-infected patients is problematic as the prevalence of different cardiac biomarkers in these patients is currently unknown. Serum lipids, which are routinely used in traditional CVD risk scores, may underestimate CVD risk in these patients, while non-hepatically produced biomarkers, including lipoprotein-associated phospholipase A2 (Lp-PLA2), may better reflect CVD risk. In this study, we aimed to evaluate the effect of sustained virologic response (SVR) on CVD risk, predicted by Lp-PLA2 mass in comparison with serum lipid levels. Results: Ninety chronic HCV-infected patients were enrolled in this study. Serum Lp-PLA2 mass was measured before and after HCV treatment via direct-acting antivirals and compared with the changes in serum lipids and Framingham risk score (FRS). The Lp-PLA2 level was categorized into high (>235 ng/ml) or low predicted CVD risk (≤235 ng/ml). Mean Lp-PLA2 mass significantly decreased from 322.37 ± 79.15 ng/ml to 263.79 ± 51.804 ng/ml with SVR, and the number of high-risk patients significantly dropped from 82.22 to 60% after treatment. Total cholesterol, low-density lipoprotein, and high-density lipoprotein levels were low/optimal at baseline (170 ± 40.34 mg/dl, 71.98 ± 24.12 mg/dl, and 48.43 ± 6.79 mg/dl) and significantly increased with SVR (195.66 ± 55.68 mg/dl, 103.24 ± 46.57 mg/dl, and 53.91 ± 8.67 mg/dl). According to FRS, only 30% of patients were moderate/high risk at baseline and insignificantly declined to 28.89% post-treatment. Conclusion: Lp-PLA2 may be a better predictor of CVD risk in chronic HCV-infected patients. Furthermore, SVR may reduce hepatic inflammation and consequently CVD risk.