(Circulation. 2000;101:1647.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Prospective Study of Potentially Virulent Strains of Helicobacter pylori and Coronary Heart Disease in Middle-Aged Men
From the Department of Population Sciences and Primary Care (P.W., M.W., L.L., A.T.), Royal Free UCL Medical School, London, UK; the Clinical Trial Service Unit and Epidemiological Studies Unit (J.D.), University of Oxford, Oxford, UK; ICRF Cancer Epidemiology Unit (P.A.), Oxford, UK; and the Division of Gastroenterology and Institute of Infections and Immunity (C.H., J.A.), University of Nottingham, Nottingham, UK.
Correspondence to Dr Peter Whincup, Department of Public Health Sciences, St George’s Hospital Medical School, Cranmer Terrace, London SW17 ORE, UK. E-mail p.whincup{at}sghms.ac.uk
Background—Studies are needed to test claims that potentially virulent strains of Helicobacter pylori are more strongly related to coronary heart disease (CHD) than are other strains.
Methods and Results—We measured serum IgG antibodies to mixed H pylori antigens and separately to the virulence-associated H pylori antigen CagA (cytotoxin-associated gene product A) in 505 CHD cases and in 1025 age-matched controls "nested" in a prospective study of 7735 British men (mean duration of follow-up in controls, 16 years). Of the 505 cases, 401 (79%) were seropositive for H pylori antibodies compared with 740 (72%) of the 1025 controls, yielding an odds ratio for CHD of 1.55 (95% CI 1.19 to 2.03), which fell to 1.30 (95% CI 0.88 to 1.90) after adjustments were made for standard vascular risk factors and indicators of socioeconomic status. Of the CHD cases, 240 (48%) were seropositive for IgG antibodies to CagA compared with 450 (44%) of the controls. When CagA-seropositive individuals were compared with H pylori–seronegative individuals, the odds ratio for CHD was 1.42 (95% CI 1.06 to 1.91), which fell to 1.10 (95% CI 0.71 to 1.71) after adjustments. In an analysis restricted to the 1141 (75%) H pylori–seropositive participants, the odds ratio for CHD was 1.0 (95% CI 0.78 to 1.29) in CagA–seropositive men. No strong associations were observed between H pylori seropositivity and blood lipids, blood pressure, markers of systemic inflammation, or plasma homocysteine.
Conclusions—H pylori infection is not strongly related to the incidence of CHD in late middle-aged men, and CagA-positive strains appear to be no more strongly related to the disease than other strains. However, further studies are required to confirm or refute the existence of any moderate associations, particularly at younger ages.
Key Words: coronary disease • epidemiology • infection • men
This article has been cited by other articles:
 |
|
 |
|
  J Sheehan, P M Kearney, S O Sullivan, C Mongan, E Kelly, and I J Perry Acute coronary syndrome and chronic infection in the Cork coronary care case-control study Heart, January 1, 2005; 91(1): 19 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Walker, P. Whincup, and A. Shaper The British Regional Heart Study 1975-2004 Int. J. Epidemiol., December 1, 2004; 33(6): 1185 - 1192. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Diomedi, A. Pietroiusti, M. Silvestrini, B. Rizzato, L. M. Cupini, F. Ferrante, A. Magrini, A. Bergamaschi, A. Galante, and G. Bernardi CagA-positive Helicobacter pylori strains may influence the natural history of atherosclerotic stroke Neurology, September 14, 2004; 63(5): 800 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G.D.O. Lowe, J. Danesh, S. Lewington, M. Walker, L. Lennon, A. Thomson, A. Rumley, and P.H. Whincup Tissue plasminogen activator antigen and coronary heart disease: Prospective study and meta-analysis Eur. Heart J., February 1, 2004; 25(3): 252 - 259. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Mayr, S. Kiechl, M. A. Mendall, J. Willeit, G. Wick, and Q. Xu Increased Risk of Atherosclerosis Is Confined to CagA-Positive Helicobacter pylori Strains: Prospective Results From the Bruneck Study Stroke, March 1, 2003; 34(3): 610 - 615. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Beaglehole and P. Magnus The search for new risk factors for coronary heart disease: occupational therapy for epidemiologists? Int. J. Epidemiol., December 1, 2002; 31(6): 1117 - 1122. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.H. Whincup, J. Danesh, M. Walker, L. Lennon, A. Thomson, P. Appleby, A. Rumley, and G.D.O. Lowe von Willebrand factor and coronary heart disease. Prospective study and meta-analysis Eur. Heart J., November 2, 2002; 23(22): 1764 - 1770. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Pietroiusti, M. Diomedi, M. Silvestrini, L. M. Cupini, I. Luzzi, M. J. Gomez-Miguel, A. Bergamaschi, A. Magrini, T. Carrabs, M. Vellini, et al. Cytotoxin-Associated Gene-A-Positive Helicobacter pylori Strains Are Associated With Atherosclerotic Stroke Circulation, July 30, 2002; 106(5): 580 - 584. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Koenig, N. Khuseyinova, M. M. Hoffmann, W. Marz, M. Frohlich, A. Hoffmeister, H. Brenner, and D. Rothenbacher CD14 C(-260)->T polymorphism, plasma levels of the soluble endotoxin receptor CD14, their association with chronic infections and risk of stable coronary artery disease J. Am. Coll. Cardiol., July 3, 2002; 40(1): 34 - 42. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R K Singh, A D McMahon, H Patel, C J Packard, B J Rathbone, and N J Samani Prospective analysis of the association of infection with CagA bearing strains of Helicobacter pylori and coronary heart disease Heart, July 1, 2002; 88(1): 43 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. W. Kerrigan, I. Douglas, A. Wray, J. Heath, M. F. Byrne, D. Fitzgerald, and D. Cox A role for glycoprotein Ib in Streptococcus sanguis-induced platelet aggregation Blood, June 28, 2002; 100(2): 509 - 516. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Gabrielli, P. Pola, A. Gasbarrini, P. U. Heuschmann, M. Gesslein, B. Craiovan, B. Neundoerfer, and P. L. Kolominsky-Rabas Helicobacter pylori, CagA-Positive Strains, and Ischemic Stroke * Response Stroke, June 1, 2002; 33(6): 1453 - 1454. [Full Text] [PDF]
|
|
|
|
 |
|
 C. Stollberger and J. Finsterer Role of Infectious and Immune Factors in Coronary and Cerebrovascular Arteriosclerosis Clin. Vaccine Immunol., March 1, 2002; 9(2): 207 - 215. [Full Text] [PDF]
|
|
|
|
|
|
J. Danesh, P. Whincup, S. Lewington, M. Walker, L. Lennon, A. Thomson, Y.-K. Wong, X. Zhou, and M. Ward Chlamydia pneumoniae IgA titres and coronary heart disease. Prospective study and meta-analysis Eur. Heart J., March 1, 2002; 23(5): 371 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Espinola-Klein, H. J. Rupprecht, S. Blankenberg, C. Bickel, H. Kopp, G. Rippin, A. Victor, G. Hafner, W. Schlumberger, and J. Meyer Impact of Infectious Burden on Extent and Long-Term Prognosis of Atherosclerosis Circulation, January 1, 2002; 105(1): 15 - 21. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A F M Stone, P Risley, H S Markus, B K Butland, D P Strachan, P C Elwood, and M A Mendall Ischaemic heart disease and Cag A strains of Helicobacter pylori in the Caerphilly heart disease study Heart, November 1, 2001; 86(5): 506 - 509. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. E. Lacy and J. Rosemore Helicobacter pylori: Ulcers and More: The Beginning of an Era J. Nutr., October 1, 2001; 131(10): 2789S - 2793. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Ridker, J. Danesh, L. Youngman, R. Collins, M. J. Stampfer, R. Peto, and C. H. Hennekens A Prospective Study of Helicobacter pylori Seropositivity and the Risk for Future Myocardial Infarction among Socioeconomically Similar U.S. Men Ann Intern Med, August 7, 2001; 135(3): 184 - 188. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. J. Rupprecht, S. Blankenberg, C. Bickel, G. Rippin, G. Hafner, W. Prellwitz, W. Schlumberger, and J. Meyer Impact of Viral and Bacterial Infectious Burden on Long-Term Prognosis in Patients With Coronary Artery Disease Circulation, July 3, 2001; 104(1): 25 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Danesh, P. Whincup, M. Walker, L. Lennon, A. Thomson, P. Appleby, A. Rumley, and G. D.O. Lowe Fibrin D-Dimer and Coronary Heart Disease : Prospective Study and Meta-Analysis Circulation, May 15, 2001; 103(19): 2323 - 2327. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Danesh, P. Whincup, M. Walker, L. Lennon, A. Thomson, P. Appleby, Y.-k. Wong, M. Bernardes-Silva, M. Ward, and R. West Chlamydia pneumoniae IgG titres and coronary heart disease: prospective study and meta-analysis Commentary: Adjustment for potential confounders may have been taken too far BMJ, July 22, 2000; 321(7255): 208 - 213. [Abstract] [Full Text]
|
|