Should H. pylori screening be integrated into MI care protocols?

Helicobacter pylori is considered a modifiable and exacerbating risk factor in influencing post-myocardial infarction (MI) upper gastrointestinal (GI) bleeding, either due to antithrombotic therapies or other mechanisms. Numerous studies suggest high prevalence of H. pylori in post-MI patients, emphasizing the role of screening of H. pylori and timely introduction of eradication therapy in infected individual as a cost-effective strategy. H. pylori is not only involved in post-MI bleeding but also play a role in triggering myocardial events and its recurrences through plaque destabilization, inflammatory response while its role in dyslipidemia remains inconsistent. This issue is under investigation since 2000 and had shown a significant relationship between involvement of H. pylori (especially CagA strains) and MI, role of genetics and environmental factors in triggering H. pylori in MI patients; however, most evidence up to date are either observational or cohort studies. Current randomized controlled trials (RCTs) suggest the role of targeted screening in high-risk population and area proved to be beneficial than blanket screening. However, lack of subgroup analysis with RCTs and long-term follow-up is necessary to establish the role H. pylori screening in preventing recurrent MI, reducing upper GI bleeding and cardiovascular outcomes. Furthermore, integrating inflammatory biomarkers and genetic factors in screening might help in risk stratification.