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Advanced Fibrosis and Cardiometabolic Risk Burden Increase Major Cardiovascular Events in Chronic Hepatitis C

Pei-Chien Tsai1, Chung-Feng Huang1,2,3,4, Ming-Lun Yeh1,2,3,4

  • 1Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Alimentary Pharmacology & Therapeutics
|December 26, 2025
PubMed

Insights

Cardiometabolic risk factors (CMRFs) and advanced liver disease increase major adverse cardiovascular events (MACEs) risk in patients with chronic hepatitis C (CHC) and steatotic liver disease (SLD) after treatment. Prioritizing CMRF management is crucial for high-risk individuals.

Area of Science:

  • Cardiology
  • Hepatology
  • Epidemiology

Background:

  • Steatotic liver disease (SLD) and cardiometabolic risk factors (CMRFs) are prevalent in chronic hepatitis C (CHC) patients.
  • The cardiovascular risk post-sustained virological response (SVR) in CHC patients with SLD, particularly metabolic dysfunction-associated steatotic liver disease (MASLD), requires further investigation.

Purpose of the Study:

  • To evaluate the impact of CMRFs on cardiovascular outcomes in CHC patients with MASLD after achieving SVR.
  • To identify predictors of major adverse cardiovascular events (MACEs) in this patient cohort.

Main Methods:

  • A nationwide multicenter cohort study in Taiwan involving patients with SLD post-SVR.
  • Assessment of CMRFs and liver fibrosis stage.
  • Competing risk analyses using Grey's method and Cox regression to determine MACEs risk.

Main Results:

  • Higher MACEs incidence was observed in MASLD patients compared to simple SLD patients (190.2 vs. 84.0 per 10,000 person-years).
  • Independent predictors of MACEs included age, advanced fibrosis, chronic kidney disease (CKD), and CMRFs burden.
  • MACEs risk escalated with increasing CMRFs burden (aHR 1.72 for one CMRF to 2.33 for ≥four CMRFs).

Conclusions:

  • CMRFs burden, advanced fibrosis, and CKD are significant predictors of MACEs in CHC patients with MASLD post-SVR.
  • Intensified monitoring and management of CMRFs are recommended for high-risk patients to mitigate cardiovascular events.
Abstract

Keywords:
cardiometabolic risk factorschronic hepatitis Cmajor adverse cardiovascular eventsmetabolic dysfunction‐associated steatotic liver diseasesustained virological response

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