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Helicobacter pylori infection: a risk factor for ischaemic cerebrovascular disease and carotid atheroma
1Department of Clinical Neuroscience, King's College School of Medicine and Dentistry and the Institute of Psychiatry, London, UK. h.markus@iop.bpmf.ac.uk
Insights
Chronic Helicobacter pylori infection is a significant risk factor for ischemic cerebrovascular disease. This common bacterial infection may contribute to stroke by increasing atherosclerosis, particularly large vessel disease.
Area of Science:
- Cardiology
- Neurology
- Infectious Disease
Background:
- Chronic Helicobacter pylori infection is linked to ischemic heart disease.
- The precise mechanism of H. pylori's influence on cardiovascular health is not fully understood.
Purpose of the Study:
- To investigate if H. pylori infection is a risk factor for ischemic cerebrovascular disease.
- To explore the association between H. pylori seropositivity and stroke subtypes.
Main Methods:
- A case-control study involving 238 patients and 119 controls.
- H. pylori seropositivity determined by serum samples.
- Stroke subtypes classified by pathogenic mechanisms; carotid atheroma assessed via duplex ultrasound.
Main Results:
- H. pylori seropositivity was significantly more common in cerebrovascular disease cases (58.8%) than controls (44.5%).
- H. pylori seropositivity was an independent risk factor for ischemic cerebrovascular disease (OR 1.63).
- Association found with large vessel disease (OR 2.58) and lacunar stroke (OR 2.21); increased carotid stenosis noted in seropositive patients.
Conclusions:
- Chronic H. pylori infection is an independent risk factor for ischemic cerebrovascular disease.
- H. pylori may contribute to cerebrovascular disease by promoting atherosclerosis.
- Further research into H. pylori's role in vascular disease is warranted.
Objectives:
Chronic Helicobacter pylori infection has been associated with ischaemic heart disease although the mechanism by which it mediates this effect remains unclear. The objective was to determine whether it is also a risk factor for ischaemic cerebrovascular disease
Methods:
A total of 238 patients and 119 controls were studied. Patients were characterised into stroke subtypes based on pathogenic mechanisms and carotid atheroma load was estimated using duplex ultrasound. H pylori seropositivity was determined on serum samples.
Results:
H pylori seropositivity was more common in cases (58.8% v 44.5%, p=0.01). The odds ratio for cerebrovascular disease associated with seropositivity was 1.78 (95% confidence interval (95% CI) 1.14-2.77), and this remained significant after controlling for other risk factors including socioeconomic status (1.63 (95% CI 1.02-2.60). H pylori seropositivity was associated with large vessel disease (odds ratio 2.58 (95% CI 1.44-4.63), p=0.001) and lacunar stroke (odds ratio 2.21 (95% CI 1.12-4.38), p=0.02) but not stroke due to cardioembolism or unknown aetiology (odds ratio 1.16 (95% CI 0.66-2.02), p=0.5). Mean (SD) carotid stenosis was greater in patients seropositive for H pylori (37.3 (29.7) v 27.9 (26.2)%, p=0.01). There was no difference in the prevalence of seropositivity between patients with stroke and transient ischaemic attack (59.6% v 58.6%, p=0.9)
Conclusion:
Chronic H pylori infection is an independent risk factor for ischaemic cerebrovascular disease and may act, at least in part, by increasing atherosclerosis.