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Infection by CagA-Positive Helicobacter pylori Strains in Patients with Ischemic Heart Disease: Prevalence and Association with Exercise-Induced Electrocardiographic Abnormalities

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Abstract

The role of H. pylori infection in increasing the risk of ischemic heart diseases (IHD) is still debated. We determined serologically the prevalence of overall H. pylori and CagA-positive H. pylori infection in 63 consecutive patients with IHD and 189 gender- and age-matched controls. We also determined in patients the influence of the infection and the CagA serological status on the results of an exercise ECG test and other parameters considered possible variables that may enhance the risk of IHD. The prevalence of H. pylori infection in patients and controls was 79.3% and 73.0%, respectively (P = 0.403) and that of CagA-positive H. pylori infection was 69.8% and 42.3%, respectively (P = 0.0002). The scores of the ECG S-T segment and T-wave abnormalities in the course of an exercise ECG in uninfected patients and in patients infected by CagA-negative and CagA-positive H. pylori strains were (mean ± sd): 1.59 ± 0.67, 1.92 ± 0.64, and 2.19 ± 0.70, respectively; (P = 0.011, 95% confidence limits of difference 0.15–1.07, CagA-positive infected vs uninfected patients). There was no intergroup difference in the levels of peripheral whiteblood cells, glucose, cholesterol, triglycerides, creatinine, and systolic and diastolic pressure. In conclusion, genetic heterogeneity of H. pylori could possibly explain some conflicting results concerning the association of H. pylori infection with IHD. Coronary vessels of IHD patients infected by CagA-positive H. pylori strains may be damaged more severely than those of uninfected patients.

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REFERENCES

  1. Noll G: Pathogenesis of atherosclerosis: A possible relation to infection. Atherosclerosis 140(suppl 1):S3–S9, 1998

    PubMed  Google Scholar 

  2. Becker AE, de Boer OJ, van Der Wal, AC: The role of inflammation and infection in coronary artery disease. Annu Rev Med 52:289–297, 2001

    PubMed  Google Scholar 

  3. Epstein SE, Zhuo YF, Zhu J: Infection and atherosclerosis. Emerging mechanistic paradigms. Circulation 100:e20–e28, 1999

    PubMed  Google Scholar 

  4. Danesh J, Collins RO, Peto R: Chronic infections and coronary heart disease: Is there a link? Lancet 350:430–436, 1997

    PubMed  Google Scholar 

  5. Svrjaken J, Valtonen VV, Iivaninen M, Kaste M, Hutten JK: Preceding infections as an important risk factor for ischaemic brain infarction in young and middle aged patients. Br Med J 296:1156–1160, 1988

    Google Scholar 

  6. Feingold K, Grunfeld C: Role of cytokines in inducing hyperlipidaemia. Diabetes 41(suppl 2):97–101, 1992

    PubMed  Google Scholar 

  7. Baumann H, Gauldie J: The acute phase response. Immunol Today 15:74–80, 1994

    PubMed  Google Scholar 

  8. Graham D: Campylobacter pylori and peptic ulcer disease. Gastroenterology 96:615–625, 1989

    PubMed  Google Scholar 

  9. Parsonnet J: Helicobacter pylori and gastric cancer. Gastroenterol Clin North Am 22:89–104, 1993

    PubMed  Google Scholar 

  10. Wotherspoon AC, Ortiz Hidalgo C, Falzon MR, Isaacson PG: Helicobacter pylori-associated gastritis and primary B-cell gastric lymphoma. Lancet 338:1175–1176, 1991

    PubMed  Google Scholar 

  11. Graham DY, Osato MS, Olson CA, Zhang J, Figura N: Effect of H. pylori infection and CagA status on leukocyte counts and liver function tests: extra-gastric manifestation of H. pylori infection. Helicobacter 3:174–178, 1998

    PubMed  Google Scholar 

  12. Perri F, Clemante R, Festa V, Checchia De Ambrosio C, Quitadamo M, Fusillo M, Grossi E, Andriuli A: Serum tumour necrosis factor-alfa is increased in patients with Helicobacter pylori infection and CagA antibodies. Ital J Gastroenterol Hepatol 31:290–294, 1999

    PubMed  Google Scholar 

  13. Mendall MA, Goggin PM, Molineaux N, Levy J, Toosy T, Strachan D, Camm J, Northfield TC: Relation of Helicobacter pylori infection and coronary heart disease. Br Heart J 71:437–439, 1994

    PubMed  Google Scholar 

  14. Patel P, Mendall MA, Khulusi S, Northfield TC, Stracham DP: Helicobacter pylori infection in childhood: Risk factors and effect on growth. Br Med J 309:1119–1123, 1994

    Google Scholar 

  15. Tebbe B, Geilen CC, Schulzke J-D, Bojarski C, Radenhausen M, Orfanos CE: Helicobacter pylori infection and chronic urticaria. J Amer Acad Dermatol 34:685–686, 1996

    Google Scholar 

  16. Mendall MA, Goggin PM, Molineaux N, Levy J, Toosy T, Strachan D, Camm AJ, Northfield TC: Relation of Helicobacter pylori infection and coronary heart disease. Br Heart J 71:437–439, 1994

    PubMed  Google Scholar 

  17. Ossei-Gerning N, Moayyedi P, Smith S, Braunholtz D, Wilson JI, Axon AT, Grant PJ: Helicobacter pylori infection is related to atheroma in patients undergoing coronary angiography. Cardiovasc Res 37:120–124, 1997

    Google Scholar 

  18. Whincup P, Danesh J, Walker M, Lennon L, Thomson A, Appleby P, Hawkey C, Atherton J: Prospective study of potentially virulent strains of Helicobacter pylori and coronary heart disease in middle-aged men. Circulation 101:1647–1652, 2000

    PubMed  Google Scholar 

  19. Figura N: Pathogenetic mechanisms of Helicobacter pylori in gastroduodenal diseases. In Advances in Gastrointestinal Inflammation. A, Morelli, C, Surrenti, S, Fiorucci, L Santucci (eds). London; InterScience Publishing, 1999, pp 221–269

    Google Scholar 

  20. Webb PM, Crabtree JE, Forman D: Gastric cancer, cytotoxinassociated gene A-positive Helicobacter pylori, and serum pepsinogens: an international study. The Eurogast Study Group. Gastroenterology 116:269–276, 1999

    PubMed  Google Scholar 

  21. Xiang Z, Censini S, Bayeli PF, Telford JL, Figura N, Rappuoli R, Covacci A: Analysis of expression of CagA and VacA virulence factors in 43 strains of Helicobacter pylori reveals that the clinical isolates can be divided into two major types and that CagA is not necessary for expression of the vacuolating toxin. Infect Immun 63:94–98, 1995

    PubMed  Google Scholar 

  22. Ellestad MH: Stress Testing—Principles and Practice, Edition 4. Turin, Centro Scientifico Editore, 1997

    Google Scholar 

  23. Figura N, Oderda G, Verdiani S: Evaluation of a commercial ELISA kit for the serological diagnosis of Helicobacter pylori infection. Microbiologica 17:319–325, 1994

    PubMed  Google Scholar 

  24. Fong IW: Emerging relations between infectious diseases and coronary artery Can Med Assoc J 163:49–56, 2000

    Google Scholar 

  25. Mendall MA, Patel P, Asante M, Ballam L, Morris J, Strachan DP, Camm AJ, Northfield TC.: Relation of serum cytokine concentrations to cardiovascular risk factors and coronary heart disease. Heart 78:273–277, 1997

    PubMed  Google Scholar 

  26. Ameriso SF, Fridman EA, Leiguarda RC, Sevlever GE: Detection of Helicobacter pylori in human carotid atherosclerotic plaques. Stroke 32:385–391, 2001

    PubMed  Google Scholar 

  27. Blasi F, Denti F, Erba M, Cosentini R, Raccanelli R, Rinaldi A, Fagetti L, Esposito G, Ruberti U, Allegra L: Detection of Chlamydia pneumonite but not H. pylori in atherosclerotic plaques of aortic aneurysms. J Clin Microbiol 34:2766–2769, 1996

    PubMed  Google Scholar 

  28. Cammarota G, Figura N, Cianci R, Pasceri V, Fedeli P, Lenzi C, Gasbarrini G: Is there antigenic mimicry between arteriosclerotic lesions and H. pylori antigens? Clin Biochem 33:419–421, 2000

    PubMed  Google Scholar 

  29. Kowalski M, Konturek PC, Pieniazek P, Karczewska E, Kluczka A, Grove R, Kranig W, Nasseri R, Thale J, Hahn EG, Konturek SJ: Prevalence of Helicobacter pylori infection in coronary artery disease and effect of its eradication on coronary lumen reduction after percutaneous coronary angioplasty. Dig Liver Dis 33:222–229, 2001

    PubMed  Google Scholar 

  30. de Luis DA, Garcia Avello A, Lasuncion MA, Aller R, Martin de Argila C, Boixeda de Miquel D, de La Calle H: Improvement in lipid and haemostasis patterns after Helicobacter pylori infection eradication in type 1 diabetic patients. Clin Nutr 18:227–231, 1999

    PubMed  Google Scholar 

  31. Gauldie J, Richards C, Northemann W, Fey G, Baumann H: IFNB2/BSF2/IL-6 is the monocute-derived HSF that regulates receptor-specific acute phase gene regulation in hepatocytes. Ann NY Acad Sci 557:46–59, 1989

    PubMed  Google Scholar 

  32. Pober S: Cytokine-mediated activation of vascular endothelium. Am J Pathol 133:426–433, 1988

    PubMed  Google Scholar 

  33. Pasceri V, Cammarota G, Patti G, Cuoco L, Gasbarrini A, Grillo RL, Fedeli G, Gasbarrini G, Maseri A: Association of virulent Helicobacter pylori strains with ischaemic heart disease. Circulation 97:1675–1679, 1998

    PubMed  Google Scholar 

  34. Gunn M, Stephens JC, Thompson JR, Rathbone BJ, Samani NJ: Significant association of cagA positive Helicobacter pylori strains with risk of premature myocardial infarction. Heart 84:267–271, 2000

    PubMed  Google Scholar 

  35. Ponzetto A, La Rovere MT, Sanseverino P, Bazzoli F: Association of Helicobacter pylori infection with coronary heart disease Br Med J 311:711–714, 1996

    Google Scholar 

  36. Koenig W, Rothenbacher D, Hoffmeister A, Miller M, Bode G, Adler G, Hombach V, März W, Pepys MB, Brenner H: Infection with Helicobacter pylori is not a major independent risk factor for stable coronary heart disease. Lack of a role of cytotoxin-associated protein A positive strains and absence of a systemic inflammatory response. Circulation 100:2326–2331, 1999

    PubMed  Google Scholar 

  37. Maier F, Auricchio A, Nilius M, Dominguez-Munoz JE, Klein H: Lack of association between Helicobacter pylori infection and angiographically documented coronary heart disease. Gut 39(suppl 2):A92, 1996

    Google Scholar 

  38. Danesh J, Peto R: Risk factors for coronary heart disease and infection with Helicobacter pylori: Meta-analysis of 18 studies. Br Med J 316:1130–1132, 1998

    Google Scholar 

  39. Yamaoka Y, Kita M, Kodama T, Sawai N, Kashima K, Imanishi J: Induction of various cytokines and development of severe mucosal inflammation by cagA gene positive Helicobacter pylori strains. Gut 41:442–511, 1997

    PubMed  Google Scholar 

  40. Li CQ, Pignatelli B, Ohshima H: Coexpression of interleukin-8 and inducible nitric oxide synthase in gastric mucosa infected with cagA Helicobacter pylori. Dig Dis Sci 45:55–62, 2000

    Article  PubMed  Google Scholar 

  41. Ando T, Perez-Perez GI, Kusugami K, Ohsuga M, Bloch KC, Blaser MJ: Anti-CagA immunoglobulin G responses correlate with interleukin-8 induction in human gastric mucosal biopsy culture. Clin Diagn Lab Immunol 7:803–809, 2000

    PubMed  Google Scholar 

  42. Figura N, Bugnoli M, Guglielmetti P, Musmanno RA, Russi M, Quaranta S: Antibodies to vacuolating toxin of Helicobacter pylori in dyspeptic patients. In: Helicobacter pylori and Gastroduodenal Pathology. JM Pajares (ed). Springer-Verlag, Berlin, 1993, pp, 181–186

    Google Scholar 

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Authors and Affiliations

  1. Institute of Internal Medicine, University of Siena, Policlinico Le Scotte, Siena, Italy

    N. Figura, A. Palazzuoli, S. Faglia, C. Lenzi, F. Borrello, V. Palazzuoli, R. Nami, N. Dal Canto, F. De Regis, L. Gennari, N. Giordano & C. Gennari

  2. Institute of Internal Medicine, University of Bologna, Bologna, Italy

    D. Vaira

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  1. N. Figura
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Figura, N., Palazzuoli, A., Faglia, S. et al. Infection by CagA-Positive Helicobacter pylori Strains in Patients with Ischemic Heart Disease: Prevalence and Association with Exercise-Induced Electrocardiographic Abnormalities. Dig Dis Sci 47, 831–836 (2002). https://doi.org/10.1023/A:1014708520885

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