Association between Helicobacter pylori infection and angiographically demonstrated coronary artery disease: A meta-analysis

Abstract

Abstract. Coronary artery disease (CAD) is a leading cause of mortality globally. However, the etiology and pathogenesis of CAD are not fully understood. The aim of the present meta-analysis was to estimate the association between the risk of CAD and Helicobacter pylori (H. pylori) infection. A literature search was performed to identify eligible studies published prior to August 14, 2014. Fixed or random effect meta-analytical methods were used to pool the data and perform the subgroup analyses. The effect measures estimated were the odds ratios (OR) for dichotomous data reported with 95% confidence intervals (95% CI). Of the 109 studies identified using the search parameters, 26 cross-sectional studies were eligible involving 3,901 CAD patients and 2,751 controls. H. pylori infection was associated with an increased risk of CAD (OR: 1.96, 95% CI: 1.47-2.63, P<0.00001). When the adjusted ORs were used to conduct another meta-analysis, the OR value decreased, but the association remained significant (OR: 1.42, 95% CI: 1.09-1.86, P=0.008). The association between H. pylori infection and CAD risk was stronger in younger individuals than in older individuals (OR: 2.36, 95% CI 1.50-3.73 vs. OR: 1.59, 95% CI: 1.19-2.11). A significant association was observed in studies from Europe (OR: 2.11, 95% CI: 1.54-2.88, P=0.01) and the USA (OR: 1.43, 95% CI: 1.08-1.91, P=0.36). There is a potential association between H. pylori infection and the risk of CAD. The association may be influenced by age and ethnicity. IntroductionCoronary artery disease (CAD), also known as ischemic heart disease (IHD), atherosclerotic heart disease, atherosclerotic cardiovascular disease and coronary heart disease, is a leading cause of mortality globally. It is reported to have caused 7.4 million mortalities (13.2% of all deaths) in 2012 worldwide (1). The etiology and pathogenesis of CAD are not fully understood. The common risk factors, including hypertension, diabetes mellitus, smoking, obesity, serum lipids, family history and socioeconomic status, do not fully account for all cases (2). Chronic infections, including Helicobacter pylori (H. pylori) infection, are assumed to play a role in the pathogenesis of CAD (3).H. pylori is a gram-negative bacterium infecting more than half the world's population (4). The infection results in chronic gastritis, peptic ulcer disease and gastric cancer (5).It is also associated with extra-gastrointestinal conditions, including diabetes mellitus and stroke (6,7). Previous studies have focused on the association between H. pylori infection and the risk of CAD. However, the role of H. pylori in CAD remains unclear (8,9).Studies in which the potential association between H. pylori infection and CAD has been investigated have shown conflicting results. In the majority of studies, CAD was diagnosed using clinical questionnaires or on the basis of abnormalities on electrocardiograms. As patients with other diseases may also present with chest pain syndromes similar to CAD, these diagnostic methods would result i...

Helicobacter pylori infection and prevalence of stroke

“…11,12 A positive association has been proposed between Helicobacter pylori (H pylori) infection and stroke. 15,16 Given its association with persistent inflammation, H pylori was postulated to play a role in extragastric illnesses that involve inflammation, such as DM, 17 coronary artery disease, 18 and dementia. 15,16 Given its association with persistent inflammation, H pylori was postulated to play a role in extragastric illnesses that involve inflammation, such as DM, 17 coronary artery disease, 18 and dementia.…”

“…13,14 H pylori causes chronic gastritis mostly without symptoms; however, in some people, H pylori causes gastric and duodenal ulcers and even gastric cancer. 15,16 Given its association with persistent inflammation, H pylori was postulated to play a role in extragastric illnesses that involve inflammation, such as DM, 17 coronary artery disease, 18 and dementia. 19 The association between H pylori infection and stroke was addressed previously.…”

Helicobacter pylori and extragastric diseases

“…They found no association in the severity of the vessel atherosclerosis score, the Gensini score, and the angiographic severity score between H. pylori ‐positive and negative patients, but a significant correlation between arterial hypertension and H. pylori infection ( P = 0.014). A recent meta‐analysis by Yu et al involving 26 cross‐sectional studies and 3901 patients with Conorary artery Disease (CAD) and 2715 controls reported a significant association between H. pylori infection and CAD, even in the multivariate analysis (OR: 1.42; 95% CI: 1.09, 1.86; P = 0.01). Interestingly, the association was positive in studies from both Europe and the United States.…”

Helicobacter pylori infection and extragastric diseases in 2017

“…A recent meta‐analysis, focused on the association between H. pylori infection and the risk of CAD, diagnosed by coronaro‐angiography, has shown how this association can be age‐ and ethnicity‐dependent. Among 26 studies suitable for the inclusion criteria, the results showed that the risk of CAD increased nearly twofold in patients with H. pylori infection; these data were stronger in younger adults (<60 years old) and a significant association was described in studies from Europe and the U.S.A …”

“…Among 26 studies suitable for the inclusion criteria, the results showed that the risk of CAD increased nearly twofold in patients with H. pylori infection; these data were stronger in younger adults (<60 years old) and a significant association was described in studies from Europe and the U.S.A. 49 Helicobacter pylori is suspected to contribute as an infective character in the complex pathogenic basis of atherosclerosis, and other large-scale studies are needed to support the use of the eradication therapy for H. pylori as a preventive treatment for CAD. Cerebrovascular acute events have been studied in several populations of H. pylori-infected subjects, the last one linked to the presence of obstructive sleep apnea (OSA) and atrial fibrillation-related stroke.…”