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Prospective relations between Helicobacter pylori infection, coronary heart disease, and stroke in middle aged men
P H Whincup1, M A Mendall, I J Perry
1University Department of Public Health, Royal Free Hospital School of Medicine, London.
Insights
Helicobacter pylori infection was initially linked to higher risks of heart attack and stroke. However, this association was found to be significantly influenced by other factors like social class and lifestyle choices.
Area of Science:
- Cardiovascular epidemiology
- Infectious disease research
Background:
- Helicobacter pylori is a common bacterial infection.
- Childhood acquisition of H. pylori is frequent.
- Potential long-term health impacts of H. pylori are under investigation.
Purpose of the Study:
- To investigate the association between H. pylori infection and the risk of coronary heart disease and stroke.
- To determine if H. pylori infection is an independent risk factor for cardiovascular events.
Main Methods:
- A nested case-control study design was employed.
- Prospective data from men aged 40-59 were analyzed.
- Serum samples were tested for H. pylori specific IgG antibodies using ELISA.
Main Results:
- Higher seropositivity for H. pylori was observed in myocardial infarction and stroke cases compared to controls.
- H. pylori infection was associated with manual social class, smoking, and other cardiovascular risk factors.
- After adjusting for confounding factors, the association between H. pylori and myocardial infarction/stroke risk was substantially attenuated.
Conclusions:
- The observed association between H. pylori and cardiovascular disease risk was largely confounded.
- Adult social class and major cardiovascular risk factors significantly influenced the H. pylori association.
- H. pylori infection is unlikely to be an independent risk factor for myocardial infarction and stroke.
Objective:
To determine whether Helicobacter pylori, a chronic bacterial infection often acquired in childhood, is associated with increased risk of coronary heart disease and stroke later in life.
Design:
Nested case-control study.
Setting:
Prospective study of cardiovascular disease in men aged 40-59 years at entry (1978-1980) in 24 British towns.
Subjects:
135 cases of myocardial infarction and 137 cases of stroke occurring before December 1991; 136 controls were identified, frequency matched to cases by town and age group.
Methods:
Serum samples stored at entry were analysed by an enzyme linked immunosorbent assay for the presence of H pylori specific IgG antibodies.
Results:
95 of the myocardial infarction cases (70%) and 93 (68%) of the stroke cases were seropositive for H pylori compared with 78 (57%) of the controls (odds ratio for myocardial infarction 1.77, 95% confidence interval (CI) 1.06 to 2.95, P = 0.03; odds ratio for stroke 1.57, 95% CI 0.95 to 2.60, P = 0.07). Helicobacter pylori infection was associated with manual social class, residence in Northern England or Scotland, cigarette smoking, higher systolic pressure and blood glucose, and a lower height-standardised forced expiratory volume in one second. Adjustment for these factors attenuated the relation between H pylori and myocardial infarction (odds ratio = 1.31, 95% CI 0.70 to 2.43, P = 0.40) and effectively abolished the relation with stroke (odds ratio = 0.96, 0.46 to 2.02, P = 0.92). The relation between helicobacter infection and fatal myocardial infarction was slightly stronger (odds ratio 2.41, 95% CI 1.13 to 5.12) but was also markedly attenuated after adjustment (1.56, 95% CI 0.68 to 3.61).
Conclusion:
In this prospective study the association between Helicobacter pylori infection and increased risk of myocardial infarction and stroke was substantially confounded by the relation between this infection, adult social class, and major cardiovascular risk factors.