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Helicobacter pylori and cardiovascular risk: Only a dead Helicobacter is a good Helicobacter?
Sarah Wernly1, Georg Semmler2, Andreas Völkerer1
1Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University, Salzburg, Austria.
Insights
Helicobacter pylori (H. pylori) infection and cardiovascular risk are independently linked in asymptomatic individuals. H. pylori eradication is safe for cardiovascular health and recommended for gastrointestinal reasons.
Area of Science:
- Gastroenterology
- Cardiology
- Epidemiology
Background:
- Helicobacter pylori (H. pylori) infection and cardiovascular (CV) disease share common symptoms and risk factors.
- Preliminary evidence suggests a link between H. pylori positivity and increased CV risk.
- Gastroenterological guidelines recommend H. pylori eradication for patients with atherosclerosis.
Purpose of the Study:
- To investigate the independent association between H. pylori positivity and cardiovascular risk.
- To determine if shared risk factors influence the relationship between H. pylori and CV risk.
- To assess the impact of H. pylori status on CV and all-cause mortality.
Main Methods:
- A cohort of 3284 asymptomatic participants undergoing upper gastrointestinal endoscopy was analyzed.
- 10-year CV event risk was calculated using the SCORE2 risk score.
- Multivariable logistic and linear regression models were used to assess associations, adjusting for age, sex, and metabolic syndrome.
- Proportional hazard Cox regression was employed to evaluate mortality risk.
Main Results:
- H. pylori positivity was significantly associated with higher SCORE2 scores (r=0.33, p=0.006), independent of confounders.
- Higher SCORE2 scores were associated with increased odds of H. pylori positivity (aOR=1.03, p=0.02), even after multivariable adjustment.
- H. pylori positivity was not associated with increased CV or all-cause mortality over a median follow-up of 9 years.
Conclusions:
- H. pylori positivity and cardiovascular risk are independently associated in asymptomatic individuals.
- This association did not translate to differential CV mortality.
- H. pylori eradication is cardiovascularly safe and recommended for gastrointestinal indications.
Objectives:
Helicobacter pylori (H. pylori) and cardiovascular (CV) disease share common symptoms and underlie many general medical complaints. Preliminary studies suggest an association between H. pylori positivity and CV risk, and gastroenterological guidelines recommend eradication of H. pylori in patients with manifest atherosclerosis. Therefore, the aim of this study was to examine the reciprocal association of H. pylori positivity and CV risk for their independence of shared risk factors.
Methods:
We included 3284 asymptomatic participants of a colorectal cancer screening cohort who were offered and underwent upper gastrointestinal endoscopy. We calculated the 10-year risk for a CV event using the novel SCORE2 for each patient. We evaluated the association between H. pylori positivity and CV risk assessed by SCORE2 using both multilevel logistic and linear regression. We adjusted for age, sex and the concomitant diagnosis of metabolic syndrome. Lastly, we assessed the association between H. pylori status and mortality using proportional hazard Cox regression.
Results:
In total, 2659 patients were H. pylori negative and 625 H. pylori positive. Helicobacter pylori positivity was associated with SCORE2 and remained so (r = .33; 95% CI 0.09-0.57; p = .006) after adjustment for age, sex, and the diagnosis of metabolic syndrome. Also, SCORE2 was associated with higher odds for H. pylori positivity (aOR 1.03 95% CI 1.01-1.05; p = .02) even after multivariable adjustment. Helicobacter pylori positivity was associated with neither CV (HR 0.60 95% CI 0.14-2.63; p = .50) nor all-cause (HR 1.20 95% CI 0.77-1.87; p = .43) mortality during a median follow-up of 9 years.
Conclusions:
In our study, H. pylori positivity and CV risk were independently associated. This did not translate into a dissimilar CV mortality between H. pylori positive and H. pylori negative patients. However, the overwhelming majority of our patients underwent H. pylori eradication. We, therefore, think that H. pylori eradication is at least safe from a cardiovascular perspective and warranted from gastrointestinal standpoint.
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