Helicobacter pylori infection and risk of cardiovascular disease

Abstract

Background Whether Helicobacter pylori (H. pylori) infection is associated with an increased risk of cardiovascular disease (CVD) remains controversial. This study aimed to investigate the association between H. pylori infection and the risk of CVD. Methods Potentially related studies were searched in the electronic databases, including PubMed, EMBASE and Cochrane Library, from inception to 31 August 2022. Observational cohort studies that reported the multivariable‐adjusted relative risks (RRs) for composite CVD, CHD, stroke, or all‐cause mortality associated with H. pylori infection were included in the meta‐analysis, using random‐effects models. Results Forty‐one cohort studies with 230,288 participants were included. After a median follow‐up duration of 6.3 years, H. pylori infection was associated with a mildly increased risk of composite CVD (RR 1.10, 95% CI 1.03, 1.18) and coronary heart disease (RR 1.10, 95% CI 1.02, 1.18) compared with those without H. pylori infection. No significant association was observed between H. pylori infection and risk of stroke (RR 1.08, 95% CI 0.94, 1.23) or all‐cause mortality (RR 1.02, 95% CI 0.90, 1.16). Compared with cytotoxin‐associated gene‐A (CagA) negative H. pylori infection, the risk of CVD was significantly increased in patients with CagA positive H. pylori infection (RR 1.58, 95% CI 1.03, 2.41). Conclusions Helicobacter pylori infection is associated with a mildly increased risk of CVD. It may be of great public health and clinical significance to screen H. pylori infection in patients with a high risk of CVD.

Association of Helicobacter pylori Positivity With Risk of Disease and Mortality

“…A recent meta-analysis of observational studies in >270,000 individuals further linked H. pylori infection to an increased risk of stroke ( 43 ). The latest meta-analysis of cohort studies on H. pylori infection and the risk of cardiovascular disease including 230,288 patients found only a mild increase of cardiovascular risk (relative risk 1.10, 95% CI 1.03, 1.18), much smaller than previous meta-analyses and our data and no significant association with the risk of stroke ( 7 ). The cardiovascular risk, even if limited, has significant impact on public health and might become evident because H. pylori , especially CagA-positive strains, may contribute synergistically with a high-fat diet to the development of atherosclerosis and cardiovascular disease through chronic inflammatory and immunological processes ( 44 – 46 ).…”

“…In patients with IDA, main benefits for eradication are achieved in children in contrast to adults, while for immune thrombocytopenia, the evidence is less compelling for children and benefits are achieved in adults ( 2 , 4 , 5 ). An association with cardiovascular diseases has also been previously suggested, although the strength of this association is controversial and a definite mechanistic explanation is missing ( 6 , 7 ).…”

Helicobacter pylori infection and rheumatoid arthritis as risk enhancers' factors for atherosclerotic cardiovascular diseases

“…It may explain the role of the microorganism as a nontraditional factor promoting atherosclerosis, a role hypothesized since the prospective study by Mendall et al in 1994 34 . A large number of ex vivo studies, 35 clinical studies, 36–40 and meta‐analyses 41–44 have provided further evidence of this significant association. Interestingly, Lai et al reported in 2015 that the infection independently increased the risk of acute coronary disease even in the absence (or after removal) of traditional risk factors 45 .…”

The impact of Helicobacter pylori eradication with vonoprazan-amoxicillin dual therapy combined with probiotics on oral microbiota: a randomized double-blind placebo-controlled trial

“…H. pylori infection has the potential to influence the gene expression of tongue fur flora, which may establish a connection between H. pylori infection and the development of cardiovascular diseases and metabolic diseases such as lipid metabolism. Prior studies ( Chen et al, 2020 ; Sun et al, 2023 ) have provided evidence of a correlation between H. pylori infection and metabolic conditions, including dyslipidemia, hypertension, diabetes, and cardiovascular diseases. Nevertheless, the precise mechanism remains uncertain and could potentially be associated with chronic inflammatory responses, endothelial damage, and hyperhomocysteinemia induced by H. pylori infection ( Vijayvergiya, 2015 ).…”