Objective-To investigate the relation between seropositivity to chronic infections with Helicobacter pylori and Chlamydia pneumoniae and both coronary heart disease and cardiovascular risk factors.Design-Cross sectional study of a population based random sample of men. Coronary heart disease was assessed by electrocardiography, Rose angina questionnaire, and a history of myocardial infarction; serum antibody levels to H pylori and C pneumoniae were measured, risk factor levels determined, and a questionnaire administered.Setting Seropositivity to C pneumoniae was independently associated with raised fibrinogen and malondialdehyde concentrations.Conclusions-Both H pylori and C pneumoniae infections are associated with coronary heart disease. These relations are not explained by a wide range of confounding factors. Possible mechanisms include an increase in risk factor levels due to a low grade chronic inflammatory response.

Data from salivary assay to investigate the epidemiology of H pylori suggest that factors relating to the type of community in which the child lives may now be as important for acquisition of this infection as features of the family home. The greater reduction of growth among infected girls raises the possibility that H pylori infection may delay or diminish the pubertal growth spurt.

Objective-To determine whether Helicobacter pyloni, a chronic bacterial infection often acquired in childhood, is associated with increased risk of coronary heart disease and stroke later in life. Design-Nested case-control study. Setting-Prospective study of cardiovascular disease in men aged 40-59 years at entry (1978-1980) (Heart 1996;75:568-572) Keywords: coronary heart disease; Helicobacter pylori; stroke Factors acting early in life may influence adult risk of coronary heart disease,1 2 and play a part in determining its social class distribution.3 Helicobacterpylori (Hpylon) is a chronic bacterial infection which is usually acquired in childhood, particularly in socially deprived circumstances.45 Its associations with peptic ulcer disease and gastric cancer are well recognised -8; both of these conditions are associated with coronary heart disease.9 10 A recent case-control study based on prevalent coronary heart disease in middle aged men provided some support for the possibility of an association between H pylon and coronary heart disease." However, selection biases could not be excluded in that study, and only limited information was available on potential confounding factors. The problems of selection bias were addressed in a further crosssectional study in south London men, which found a strong relation between H pylon seropositivity and electrocardiographic abnormalities suggestive of myocardial ischaemia or infarction, independent of a wide range of confounding variables.'2 However, no study has yet prospectively investigated the relation between H pylon infection and coronary heart disease. We have used a nested case-control study based on a longitudinal study of cardiovascular disease in middle aged men to examine the relation between H pylon seropositivity and subsequent coronary heart disease and stroke.

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