IJCS | Volume 32, Nº2, May/June 2019

DOI: 10.5935/2359-4802.20190011 283 REVIEW ARTICLE International Journal of Cardiovascular Sciences. 2019;32(3)283-289 Mailing Address: André Gustavo da Silva Rezende Rua Neto Campelo 70, apto 902. Postal Code: 50710-450, Torre, Recife, PE - Brazil. E-mail: andregrezende@uol.com.br , andregrezende@hotmail.com Cardiac Disorder in Chronic Hepatitis C André Gustavo da Silva Rezend e, E dmundo Pessoa Lope s, Brivaldo Markman-Filh o Universidade Federal de Pernambuco, Recife, PE - Brazil Manuscript received on April 18, 2018; reviewed on July 02, 2018; accepted on August 07, 2018. HepatitisC,Chronic;LiverCirrhosis;Cardiomiopathies; Arrhytmias, Cardiac; Drug Interactions; Drug - Related Side Effects and Adverse Reactions. Keywords Abstract Chronic hepatitis C (CHC) has a high prevalence in the world. In addition to hepatic complications with cirrhosis in about 20% of patients and high risk for hepatocarcinoma, extrahepatic manifestations may also occur. Cardiac involvement in patients with CHC is associated with several factors, such as increased risk for coronary artery disease, primary cardiomyopathies, or hemodynamic and electrophysiological changes observed in liver cirrhosis. Furthermore, antiviral treatment may, in rare cases, causes cardiovascular adverse effects. Cardiac arrhythmias are the main form of clinical presentation, and, often, markers of poor prognosis in individuals with advanced liver disease. Although some mechanisms that justify these changes have already been reported, many questions remain unanswered, especially about the true involvement of the hepatitis C virus in the genesis of primary cardiac abnormalities, and the risk factors for cardiac-related complications of antiviral treatment. Introduction Chronic hepatitis C virus (HCV) infection affects more than 70 million people worldwide, accounting for about 1% of the global population. 1 In Brazil, the Ministry of Health estimates that 657,000 people are infected with HCV. 2 More than 70% of these infected individuals develop the chronic form of the disease, evolving with different degrees of liver conditions, and up to 20% develop advanced cirrhosis and 5% develop hepatocellular carcinoma. 3 The hepatic complications of hepatitis C account for about 400,000 deaths per year in the world. 1 HCV infection can be considered a systemic disease and not simply restricted to the liver. Many forms of extrahepatic manifestations have been described, especially mixed cryoglobulinemia and other lymphoproliferative diseases. In addition, several authors have described a strong association of HCVwith neurological, osteoarticular, pulmonary and thyroid disorders, as well as nephropathies (glomerulopathies), porphyria cutanea and even a higher incidence of diabetes mellitus. 4 Theassociationbetweenheart diseases andchronicHCV infection has also been described. Since cardiac diseases, as well as HCV infection, have a considerable prevalence in the general population, the two conditions would be concomitantly expected in most of these individuals. However, HCV has been implicated as a risk factor for cardiovascular changes that will be described below, such as coronary atherosclerosis, cardiomyopathies, heart disease in advanced cirrhosis, cardiac arrhythmias and cardiotoxic effects of antiviral treatment. This review aims to describe HCV-related cardiac disorders, discussing the possible pathophysiological mechanisms involved in these disorders. Coronary artery disease The association between HCV infection and increased risk of atherosclerotic disease, acute coronary syndromes (myocardial infarction and unstable angina), and fatal strokes has been reported, although the mechanisms that justify this predisposition are unclear. Ambrosino et al. published a recent meta-analysis involving 27 cohort studies and more than 200,000 HCV patients, in which they found an odds ratio of 1.38 for the development