Published Online
on July 8, 2002

A more recent version of this article appeared on July 30, 2002

This Article Full Text (PDF) All Versions of this Article: 106/5/580    most recent 01.CIR.0000023894.10871.2Fv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pietroiusti, A. Articles by Galante, A. Search for Related Content PubMed Articles by Pietroiusti, A. Articles by Galante, A. Related Collections Risk Factors Acute Cerebral Infarction

Submitted on March 6, 2002
Revised on May 14, 2002
Accepted on May 14, 2002

Cytotoxin-Associated Gene-A--Positive Helicobacter pylori Strains Are Associated With Atherosclerotic Stroke

Antonio Pietroiusti MD^*, Marina Diomedi MD, PhD, Mauro Silvestrini MD, Letizia Maria Cupini MD, Ida Luzzi PhD, Maria Jesus Gomez-Miguel PhD, Antonio Bergamaschi MD, Andrea Magrini MD, Tiziana Carrabs MD, Marina Vellini MD, and Alberto Galante MD

From Medical Semiology and Methodology (A.P., M.V., A.G.), the Department of Neurological Sciences (M.D., M.L.C.), and Occupational Medicine (A.B., A.M.), Tor Vergata University, Rome, Italy; the Department of Bacteriology and Medical Mycology (I.L., M.J.G.-M.), Istituto Superiore di Sanità, Rome, Italy; Clinica San Raffaele (T.C.), Velletri, Italy; and Clinic of Neurology (M.S.), University of Ancona, Ancona, Italy.

^* To whom correspondence should be addressed. E-mail: pietroiusti{at}med.uniroma2.it.

Background—It is uncertain whether Helicobacter pylori is associated with ischemic syndromes and whether this association is mediated by the induction of atherosclerosis. In this study, we tested the hypothesis that atherosclerotic stroke shows a selective association with virulent H pylori strains.

Methods and Results—The seroprevalence of infection by H pylori and by strains bearing the cytotoxin-associated gene-A (CagA), a strong virulence factor, was assessed by ELISA in 138 patients with large-vessel stroke (group A), in 61 patients with cardioembolic stroke (group B), and in 151 healthy control subjects. The 3 groups had a similar socioeconomic status. Serum levels of C-reactive protein were also measured by ELISA. The prevalence of infection was 71% in group A, 63.9% in group B, and 70.2% in the control group (P=NS), whereas the prevalence of CagA-positive strains was higher in group A than in group B (42.8% versus 19.7%, respectively; odds ratio 3.04, 95% CI 1.43 to 6.49; P<0.001) and higher in group A than in the control group (42.8% versus 17.9%, respectively; odds ratio 4.3, 95% CI 2.12 to 8.64; P<0.001), after adjusting for main cardiovascular risk factors and social class. A trend toward a difference in C-reactive protein was observed between CagA-positive (2.00±3.43 [mean±SD] mg/dL) and CagA-negative (1.31±1.72 [mean±SD] mg/dL) patients (P=0.072, Mann-Whitney U test).

Conclusions—The association between H pylori and acute cerebrovascular disease seems to be due to a higher prevalence of more virulent H pylori strains in patients with atherosclerotic stroke.

Key words: infection • genes • stroke • proteins

This article has been cited by other articles:

				F. Megraud and P. Lehours Helicobacter pylori Detection and Antimicrobial Susceptibility Testing Clin. Microbiol. Rev., April 1, 2007; 20(2): 280 - 322. [Abstract] [Full Text] [PDF]

				A. Pietroiusti, M. Giuliano, A. Magrini, A. Bergamaschi, and A. Galante Cytotoxin-Associated Gene A Strains of Helicobacter Pylori Represent a Risk Factor for the Development of Microalbuminuria in Type 2 Diabetes. Diabetes Care, June 1, 2006; 29(6): 1399 - 1401. [Full Text] [PDF]

				F.C. Gibson III, H. Yumoto, Y. Takahashi, H.-H. Chou, and C.A. Genco Innate Immune Signaling and Porphyromonas gingivalis-accelerated Atherosclerosis Journal of Dental Research, February 1, 2006; 85(2): 106 - 121. [Abstract] [Full Text] [PDF]

				D. Larizza, V. Calcaterra, M. Martinetti, R. Negrini, A. De Silvestri, M. Cisternino, A. M. Iannone, and E. Solcia Helicobacter pylori Infection and Autoimmune Thyroid Disease in Young Patients: The Disadvantage of Carrying the Human Leukocyte Antigen-DRB1*0301 Allele J. Clin. Endocrinol. Metab., January 1, 2006; 91(1): 176 - 179. [Abstract] [Full Text] [PDF]

				M. Diomedi, A. Pietroiusti, M. Silvestrini, B. Rizzato, L. M. Cupini, F. Ferrante, A. Magrini, A. Bergamaschi, A. Galante, and G. Bernardi CagA-positive Helicobacter pylori strains may influence the natural history of atherosclerotic stroke Neurology, September 14, 2004; 63(5): 800 - 804. [Abstract] [Full Text] [PDF]

				B. Ludewig, P. Krebs, and E. Scandella Immunopathogenesis of atherosclerosis J. Leukoc. Biol., August 1, 2004; 76(2): 300 - 306. [Abstract] [Full Text] [PDF]

				M. R. Preusch, A. J. Grau, F. Buggle, C. Lichy, J. Bartel, C. Black, and J. Rudi Association Between Cerebral Ischemia and Cytotoxin-Associated Gene-A-Bearing Strains of Helicobacter pylori Stroke, August 1, 2004; 35(8): 1800 - 1804. [Abstract] [Full Text] [PDF]

				M. Gabrielli, A. Santoliquido, F. Cremonini, V. Cicconi, M. Candelli, M. Serricchio, P. Tondi, R. Pola, G. Gasbarrini, P. Pola, et al. CagA-positive cytotoxic H. pylori strains as a link between plaque instability and atherosclerotic stroke Eur. Heart J., January 1, 2004; 25(1): 64 - 68. [Abstract] [Full Text] [PDF]

				P. J. Lindsberg and A. J. Grau Inflammation and Infections as Risk Factors for Ischemic Stroke Stroke, October 1, 2003; 34(10): 2518 - 2532. [Abstract] [Full Text] [PDF]

				M. Mayr, S. Kiechl, M. A. Mendall, J. Willeit, G. Wick, and Q. Xu Increased Risk of Atherosclerosis Is Confined to CagA-Positive Helicobacter pylori Strains: Prospective Results From the Bruneck Study Stroke, March 1, 2003; 34(3): 610 - 615. [Abstract] [Full Text] [PDF]

				Stroke and H. pylori: What's the Story? Journal Watch Infectious Diseases, August 23, 2002; 2002(823): 5 - 5. [Full Text]