The relationship between chronic H. pylori infection, CagA seropositivity and stroke: meta-analysis
Filippo Cremonini1, Maurizio Gabrielli, Giovanni Gasbarrini
1Clinical Enteric Neuroscience, Translational and Epidemiological Research Program, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
Insights
Helicobacter pylori infection, especially CagA-positive strains, shows a modest association with stroke, particularly large vessel stroke. Further research is needed to clarify the role of these H. pylori strains in various stroke types.
Area of Science:
- Medical Research
- Infectious Diseases
- Neurology
Background:
- Conflicting evidence exists regarding Helicobacter pylori (H. pylori) chronic infection as a stroke risk factor.
- H. pylori strains carrying the cytotoxin-associated gene-A (CagA) antigen are considered more virulent.
- Understanding the specific role of H. pylori in different stroke subtypes is crucial for public health.
Purpose of the Study:
- To conduct a meta-analysis of case-control studies to evaluate the association between H. pylori infection and stroke.
- To assess the link between CagA-positive H. pylori strains and stroke risk.
- To investigate if H. pylori infection prevalence differs among stroke subtypes, specifically large vessel stroke.
Main Methods:
- A meta-analysis was performed on seven cross-sectional, case-control studies.
- Seroprevalence of H. pylori and CagA was compared between stroke patients and control groups.
- Stratified analysis was conducted for large vessel stroke patients versus other stroke types and controls.
Main Results:
- A modest association was found between H. pylori seropositivity and stroke (pooled OR 1.49).
- Anti-CagA positivity showed a stronger association with stroke (pooled OR 2.23).
- Patients with large vessel stroke had significantly higher odds of H. pylori infection compared to other stroke types and controls (OR 1.65 and 1.61, respectively).
Conclusions:
- H. pylori infection, particularly CagA-positive strains, is modestly associated with stroke, with a stronger link to large vessel stroke.
- The findings suggest a potential role for CagA-positive H. pylori in specific stroke etiologies.
- Future prospective studies should focus on elucidating the role of CagA-positive H. pylori strains in different stroke subclasses.
Aims:
There is contrasting evidence on the relevance of chronic infection by Helicobacter pylori (H. pylori) as a risk factor for stroke. We performed a meta-analysis of case-control studies to assess association of H. pylori infection and more virulent H. pylori strains, bearing the cytotoxin-associated gene-A (CagA) antigen, with different types of stroke.
Methods:
Outcome measures were: H. pylori and CagA seroprevalence in (1) patients with stroke versus controls, and (2) patients with stroke due to large vessel stroke versus patients with other types of stroke and controls.
Results:
Seven cross-sectional, case-control studies were included. Odds ratio for individual case-control studies and pooled OR for the association between H. pylori seropositivity and stroke was 1.49 (95% CI 1.24-1.81), for the association between stroke and anti-CagA positivity was 2.23 (95% CI 1.49-3.36). Patients with large vessel stroke had higher odds for H. pylori infection than patients with other types of stroke (odds ratio 1.65; 95% CI 1.12-2.45), and than controls (odds ratio 1.61; 95% CI 1.13-2.32).
Conclusions:
Association between H. pylori positivity, anti-CagA positivity and stroke is modest and seems higher with stroke due to large vessel disease. This meta-analysis suggests that the role of CagA positive H. pylori strains in different stroke etiologic subclasses should be the target of future prospective investigation.
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