Is there a link between chronic Helicobacter pylori infection and coronary heart disease?
1Nuffield Department of Clinical Medicine, University of Oxford, UK. john.danesh@balliol.ox.ac.uk
Insights
Epidemiological studies suggest a link between coronary heart disease and Helicobacter pylori infection, but a systematic review found no strong correlations. Residual confounding factors may explain reported associations.
Area of Science:
- Cardiovascular Epidemiology
- Infectious Disease Research
Background:
- Numerous epidemiological studies have explored the association between coronary heart disease (CHD) and IgG serum antibodies to Helicobacter pylori (H. pylori).
- Interpretations of these studies vary, with some suggesting a causal link and others reporting weak or no correlations.
Purpose of the Study:
- To systematically review and evaluate the evidence for an association between coronary heart disease and Helicobacter pylori infection.
Main Methods:
- A systematic review of the published epidemiological literature was conducted.
- Identification and analysis of over twenty relevant reports.
Main Results:
- Smaller case-control studies, particularly those with opportunistic controls and limited confounder adjustment, tended to report higher odds ratios.
- Prospective studies generally reported no strong correlations between CHD and H. pylori infection.
- Combined analyses of existing studies were insufficient to confirm or refute weak associations due to limited sample sizes.
Conclusions:
- Reported weak associations between CHD and H. pylori may be attributable to residual confounding by other causal risk factors.
- The current evidence does not strongly support a causal relationship between H. pylori infection and coronary heart disease.
Background:
A number of epidemiological studies have reported on associations of coronary heart disease and raised levels of IgG serum antibodies to Helicobacter pylori. There is substantial uncertainty about the interpretation of these reports, however, as some authors have emphasised the most extreme findings to claim that a causal association exists, whereas others have reported the existence of no strong correlations.
Methods:
A systematic review of the published literature was conducted.
Results:
More than twenty relevant epidemiological reports were identified. There was a tendency towards larger odds ratios in smaller case-control studies that recruited controls opportunistically (e.g., hospital inpatients without heart disease) and that did not adjust for many confounders. Overall, the prospective studies reported no strong correlations between coronary heart disease and H. pylori infection. Even in a combined analysis, however, these studies were too small to be able to confirm or refute the existence of weak associations.
Conclusion:
Residual confounding by causal risk factors may well account for the weak associations that have been reported between coronary heart disease and H. pylori.
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