Effects of hepatitis C virus on cardiovascular risk in infected patients: a comparative study.

The role of hepatitis C virus (HCV) in the pathogenesis of atherosclerosis and cardiovascular events is unclear. The aim of this study was to evaluate the direct effect of HCV on cardiovascular risk and correlate it with pro and anti-inflammatory cytokines in patients with HCV. HCV monoinfected patients, genotype 1, naive, non-obese (BMI<30) and non-diabetics were included and compared to controls (blood donors). Patients with prior diagnosis of cardiovascular diseases, hypertension, chronic renal failure, cancer and chronic use of lipid-lowering drugs or immunosuppressants were excluded. Age, BMI, systolic blood pressure (SBP) and diastolic (DBP), fasting glucose and lipid levels were determined. Serum cytokines (IL-6, IL-10 and TNF-α) and Framingham score were also evaluated. 62 HCV patients, 34 (54.8%) were males and none of them was smoking. The Framingham scores (median and 25th and 75th percentiles) were 12% (6.5-14%), showing an intermediate cardiovascular risk in patients with HCV. There was significant direct correlation between Framingham and total cholesterol (p=0.043) and DBP (p=0.007). HDL-C (p=0.002) was inversely correlated with the Framingham score. HCV patients had higher levels of proinflammatory cytokines (IL-6 and TNF-α) compared to controls (p<0.0001) and the relation of proinflammatory/anti-inflammatory TNF-α/IL10 and IL-6/IL10 were higher in HCV patients (p<0.01). The Framingham score was directly correlated to IL-6 and TNF-α, but differences were not statistically significant. Patients with HCV monoinfected, nonobese, naïve and non diabetic have an intermediate cardiovascular risk, as measured by the Framingham score and high levels of proinflammatory cytokines (IL-6 and TNF).

Predictors of hypertension following successful renal transplantation: a population-based study.

INTRODUCTION: Hypertension is common following renal transplantation. It is associated with poorer graft survival as well as reduced expectancy and quality of life among transplant recipients. This study sought to evaluate the prevalence of hypertension and its predictors among a representative sample of the population of adult kidney transplant recipients in southern Brazil. METHODS: This cross-sectional, multicenter study evaluated 272 adult kidney transplant recipients. The patients were classified as hypertensive if there was a previous diagnosis of high blood pressure and/or they were receiving antihypertensive drugs. The analysis used multivariate linear regression with the number of antihypertensive agents as a dependent variable. RESULTS: The final regression model showed that patient age (beta 0.23; 95% confidence interval [CI], 0.04-0.43; P = .02), nonwhite skin color (beta 0.32; 95% CI, 0.09-0.54; P = .005), serum creatinine reciprocal square root (beta 0.15; 95% CI, 0.0001-0.30; P = .05), steroid use (beta 0.62; 95% CI, 0.28-0.95; P < .001), and cyclosporine prescription (beta 0.39; 95% CI, 0.19-0.59; P < .001) were independent predictors of a greater number of antihypertensive drugs. CONCLUSIONS: This study analyzed high blood pressure predictors among a representative sample of a kidney transplant population. Its findings confirmed previous reports that cyclosporine and steroid use are independent predictors of high blood pressure after kidney transplantation, as are older age, nonwhite skin color, and reduced allograft function. The association of cyclosporine and steroid use with the need for a greater number of antihypertensive agents after kidney transplantation must be considered in the choice of an immunosuppressive regimen.