From the Division of Epidemiology, School of Public Health, University of
Minnesota, Minneapolis (A.R.F.); School of Hygiene and Public Health, Johns
Hopkins University, Baltimore, Md (F.J.N.); National Institutes of Health,
National Heart, Lung, and Blood Institute, Bethesda, Md (P.S.); Collaborative
Studies Coordinating Center, Chapel Hill, NC (L.E.C.); and Department of
Medicine, Veterans Affairs Medical Center, Baylor College of Medicine,
Houston, Tex (D.Y.G.).
Background—Several epidemiological
and clinical reports have suggested seropositivity for
Helicobacter pylori may be a risk factor for
coronary heart disease. However, there has been no prospective
study of this association involving an ethnically diverse sample of
middle-aged men and women.
Methods and Results—Using a prospective, case-cohort design, we
determined H pylori seropositivity in relation to
coronary heart disease incidence over a median follow-up period
of 3.3 years among middle-aged men and women. There were 217 incident
coronary heart disease cases and a cohort sample of 498. We
determined H pylori antibody status by measuring IgG
antibody to the high-molecular-weight cell-associated proteins of
H pylori using a sensitive and specific ELISA. The
prevalence of H pylori seropositivity was higher in
blacks than whites, in those with less than high school education, in
those with lower plasma pyridoxal 5'-phosphate and higher
homocyst(e)ine concentrations, in those who did not use vitamin
supplements, in those with higher fibrinogen levels, and in those
seropositive for cytomegalovirus and herpes simplex type I (all
P<0.05). The age-, sex-, race-, and field
center–adjusted hazard ratio of coronary heart disease for
H pylori seropositivity was 1.03 (95% CI=0.68 to 1.57).
After adjustment for other risk factors, including fibrinogen,
cytomegalovirus seropositivity, and herpes simplex type I
seropositivity, the hazard ratio was 0.85 (95% CI=0.43 to 1.69).
H pylori seropositivity also was not associated with
increased mean intima-media thickness of the carotid artery, a measure
of subclinical atherosclerosis.
Conclusions—H pylori infection is probably not an
important contributor to clinical coronary heart disease
events.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Helicobacter pylori Seropositivity and Coronary Heart Disease Incidence
Key Words: Helicobacter pylori • coronary disease • epidemiology
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