From the Department of Public Health Sciences (D.P.S., B.K.B.), Division
of Gastroenterology, Endocrinology and Metabolism (M.A.M.), Department of
Medical Microbiology (D.C.), St George's Hospital Medical School,
London; Division of Epidemiology (J.W.G.Y.), The Queen's University of
Belfast, Royal Victoria Hospital, Belfast; and the Medical Research Council
Epidemiology Unit (South Wales) (P.M.S., P.C.E.), Llandough Hospital, South
Glamorgan, United Kingdom.
Correspondence to David P. Strachan, MD, Department of Public Health Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE, United Kingdom. E-mail d.strachan{at}sghms.ac.uk
Background—Associations have
been suggested between Helicobacter pylori
seropositivity, cardiovascular risk factors, and
ischemic heart disease (IHD). The effect of this common
infection on mortality is uncertain.
Methods and Results—Plasma specimens collected during 1979 to
1983 from 1796 men in Caerphilly, South Wales, were analyzed
for IgG antibodies to H pylori. Cause of death and
occurrence of incident IHD events were ascertained over an average of
13.7 years from death certificates, hospital records, and ECG
changes at 5-yearly follow-up examinations. Seventy percent of men were
seropositive. The prevalence of IHD at entry was similar in men with
and without H pylori antibodies (odds ratio [OR],
1.10; 95% CI, 0.87 to 1.40). Seropositivity was significantly
(P<0.05) associated with poorer socioeconomic status
currently and in childhood, shorter stature, and poorer ventilatory
function at entry but not with age, smoking, body mass index, blood
pressure, total cholesterol, HDL cholesterol,
LDL cholesterol, fibrinogen, plasma viscosity, or heat
shock protein antibodies. Thirteen-year incidence of IHD was not
significantly associated with H pylori (OR, 1.05; 95%
CI, 0.80 to 1.39), but there was a stronger relationship with all-cause
mortality (OR, 1.46; 95% CI, 1.12 to 1.92) and fatal IHD (OR, 1.54;
95% CI, 1.03 to 2.30). After adjustment for
cardiovascular risk factors and both adult and
childhood socioeconomic status, ORs were slightly reduced and lost
statistical significance (OR=1.32 [95% CI, 0.99 to 1.78] for
all-cause mortality and OR=1.52 [95% CI, 0.99 to 2.34] for fatal
IHD).
Conclusions—H pylori infection is unlikely to be
as strong a risk factor for IHD as some previous studies have
suggested, but its relationship to mortality, including fatal IHD,
deserves further investigation. The mechanism underlying these
associations is unlikely to involve hypertension, circulating lipid
profile, fibrinogen, or cross-reacting antibodies to bacterial heat
shock proteins.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Relation of Helicobacter pylori Infection to 13-Year Mortality and Incident Ischemic Heart Disease in the Caerphilly Prospective Heart Disease Study
Key Words: heart diseases • epidemiology • mortality • infection • Helicobacter pylori
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