Cytotoxin-associated Gene-A-positive Helicobacter pylori strains infection increases the risk of recurrent atherosclerotic stroke

Helicobacter. 2008 Dec;13(6):525-31. doi: 10.1111/j.1523-5378.2008.00627.x.

Abstract

Background: CagA-positive Helicobacter pylori infection has been found to be associated with a first-ever atherosclerotic stroke. The aim of this study was to investigate whether these strains represent an independent risk factor for recurrent atherosclerotic stroke.

Materials and methods: We performed a longitudinal study of patients with a first-ever large vessels stroke and resulted positive at H. pylori serology. Patients had clinical examination 1 month after the acute event, and were subsequently visited or contacted by telephone up to 3 years at 6-month intervals. Sera obtained at the time of enrollment were frozen and analyzed for the presence of anti-CagA antibodies at the end of the study. The primary outcome event was any fatal or nonfatal stroke after the index stroke.

Results: One hundred seventy H. pylori-positive patients were included (n = 68 CagA positive and n = 102 CagA negative). No significant difference regarding age and other stroke risk factors was detected. According to Kaplan-Meier survival analysis, CagA-positive patients showed a significantly higher risk for stroke recurrence than CagA-negative ones (45.6% vs 17.6%; p < .001). Difference in the rate of recurrent stroke between the two groups persisted after Cox regression analysis taking into account possible confounding factors (hazard ratio = 3.5; 95% CI = 1.9-6.4; p < .001).

Conclusions: Infection with H. pylori CagA-positive strains increases the risk of recurrent atherosclerotic stroke. Seropositivity determination should be performed in order to identify high-risk patients requiring a strict clinical surveillance, and the possible beneficial effect of eradication therapy should be evaluated.

MeSH terms

  • Aged
  • Antibodies, Bacterial / blood
  • Antigens, Bacterial / biosynthesis*
  • Antigens, Bacterial / genetics
  • Atherosclerosis / epidemiology
  • Atherosclerosis / etiology*
  • Bacterial Proteins / biosynthesis*
  • Bacterial Proteins / genetics
  • Female
  • Helicobacter Infections / complications*
  • Helicobacter Infections / microbiology*
  • Helicobacter pylori / genetics
  • Helicobacter pylori / physiology*
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Recurrence
  • Risk Factors
  • Stroke / epidemiology
  • Stroke / etiology*

Substances

  • Antibodies, Bacterial
  • Antigens, Bacterial
  • Bacterial Proteins
  • cagA protein, Helicobacter pylori