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Ischemic cardiovascular disease and Helicobacter pylori. Where is the link?
R Pellicano1, E Oliaro, N Gandolfo
1Department of Gastro-Hepatology, Hospital Molinette, Turin, Italy. rinaldo_pellican@hotmail.com
Insights
Helicobacter pylori (H. pylori) infection may contribute to coronary heart disease (CHD) by promoting inflammation and platelet aggregation. Further research is needed to confirm this causal link in humans.
Area of Science:
- Cardiology
- Infectious Diseases
- Epidemiology
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality, with known risk factors insufficient to explain all epidemiological variations.
- Chronic infections and inflammation are implicated in cardiovascular diseases, and antibiotic therapy has shown promise in reducing CHD recurrence.
- The potential link between Helicobacter pylori (H. pylori) infection and CHD has been studied extensively but with heterogeneous methodologies.
Purpose of the Study:
- To review the existing evidence on the association between Helicobacter pylori infection and coronary heart disease.
- To explore potential mechanisms by which H. pylori may contribute to CHD pathogenesis.
- To highlight the need for further rigorous studies to establish a causal relationship.
Main Methods:
- Review of existing epidemiological and clinical studies on H. pylori and CHD.
- Analysis of evidence from animal studies investigating H. pylori's role in myocardial infarction.
- Examination of proposed pathogenetic mechanisms including inflammation, platelet aggregation, autoimmunity, and homocysteine levels.
Main Results:
- Animal studies suggest H. pylori can induce platelet aggregation and pro-coagulant activity, relevant to acute myocardial infarction.
- H. pylori may contribute to atherosclerosis via autoimmune responses against endothelial cells or by affecting homocysteine levels.
- Heterogeneity in previous studies complicates definitive conclusions regarding H. pylori's role in various forms of CHD.
Conclusions:
- The precise role of Helicobacter pylori in coronary heart disease is not yet fully established.
- Evidence suggests H. pylori may play a role in acute myocardial infarction and atherosclerosis.
- Further prospective and interventional studies are essential to investigate the potential causal relationship between H. pylori and CHD.
Abstract:
Coronary heart disease (CHD) is the leading cause of death in western countries. Although several major risk factors have been identified, they fail to account for all the epidemiological variants of the disease, thus warranting research into novel causal agents. Cardiovascular diseases have long been associated with chronic infections acting through the activation of inflammatory pathways, and antibiotic therapy has been shown to produce a dramatic decrease in the rate of disease recurrence in patients with a history of myocardial infarction or unstable angina. The link between Helicobacter pylori (H. pylori) infection and CHD, first described by Mendall et al. in 1994, has been the subject of a multitude of epidemiological and clinical studies; however, these have been so heterogeneous that not two of them are based on a comparable selection of patients and focused on the same kind of disease, e.g. stable coronary heart disease or acute myocardial infarction. Evidence from animal studies supports the thesis that H. pylori plays an extremely important role in the acute phase of myocardial infarction: the bacterium causes platelet aggregation and induces pro-coagulant activity in experimentally infected mice. H. pylori may also contribute to atherosclerosis through an auto-immune process against endothelial cells or an increased concentration of homocysteine in the blood due to decreased levels of folic acid and cobalamin. The exact role of H. pylori cannot yet be fully assessed: there is a clear and present need for further studies with appropriate epidemiological and clinical approaches to investigate through prospective and interventional trial the possible causal relationship between H. pylori and CHD.