From the Departments of Internal Medicine and Cardiology (V.P., G.C.,
G.P., L.C., A.G., G.F., G.G., A.M.), Institute of Microbiology (R.L.G.),
Catholic University of the Sacred Heart, Rome, Italy.
Correspondence to Vincenzo Pasceri, MD, Istituto di Cardiologia, Universitá Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Roma, Italy.
Background—Previous studies have
reported an association between chronic Helicobacter
pylori infection and ischemic heart disease. However,
it is not clear whether this association is really due to the virulence
of the bacterium or is merely the result of confounding factors (in
particular, age and social class).
Methods and Results—We assessed the prevalence of infection by
Helicobacter pylori and by strains bearing the
cytotoxin-associated gene-A (CagA), a strong virulence factor, in 88
patients with ischemic heart disease (age, 57±8 years; 74 men)
and in 88 age- and sex-matched controls (age, 57±8 years; 74 men) with
similar social background. Prevalence of Helicobacter
infection was significantly higher in patients than in controls (62%
versus 40%; P=.004), with an odds ratio of 2.8 (95%
CI, 1.3 to 7.4; P<.001) adjusted for age, sex, main
cardiovascular risk factors, and social class. Patients
with ischemic heart disease also had a higher prevalence of
CagA-positive strains (43% versus 17%; P=.0002), with
an adjusted odds ratio of 3.8 (95% CI, 1.6 to 9.1;
P<.001). Conversely, prevalence of CagA-negative
strains was similar in patients and controls (19% versus 23%), with
an adjusted odds ratio of 0.8 (95% CI, 0.4 to 1.4).
Conclusions—The association between Helicobacter
pylori and ischemic heart disease seems to be due to a
higher prevalence of more virulent Helicobacter strains
in patients. These results support the hypothesis that
Helicobacter pylori may influence atherogenesis through
low-grade, persistent inflammatory stimulation.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Association of Virulent Helicobacter pylori Strains With Ischemic Heart Disease
Key Words: heart diseases • Helicobacter pylori • risk factors
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