Association of CagA+ Helicobacter pylori infection with aortic atheroma

Background: To investigate possible association between infection with CagA + strains of Helicobacter pylori and aortic atheroma diagnosed by transesophageal echocardiography. Methods and results: One hundred and eighty-eight consecutive subjects prospectively examined for presence of aortic atheroma (localized intimal thickening of ≥3mm) by transesophageal echocardiography were tested for serum IgG antibodies against H. pylori (enzyme-linked immunosorbent assay) and CagA protein (Western blot assay). The association between infection with H. pylori , CagA status of the infecting H. pylori strains, and aortic atherosclerosis was evaluated after adjusting for coronary artery disease risk factors. There was a linear trend for presence of atheroma in subjects with CagA-positive H. pylori infection (51/81, 63%) compared to subjects with CagA-negative H. pylori infection (21/45, 46.7%) and uninfected subjects (18/62, 29%) ( p =0.003). H. pylori seropositivity was not associated with aortic atheroma (OR 2.9; 95% CI, 0.8–10.3; p =0.11) when CagA status is not taken into account. On multivariate analysis, parameters associated with risk of aortic atheroma were CagA-positive H. pylori seropositivity (OR 4.4; 95% CI, 1.4–14.7; p =0.01), older age (OR 1.2; 95% CI, 0.9–14.7; p =0.01), having ever smoked cigarettes (OR 3.6; 95% CI, 1.3–10.0; p p =0.02). Conclusions: After controlling for H. pylori infection and coronary artery disease risk factors, infection with a CagA-positive strain of H. pylori was independently associated with aortic atherosclerosis. This study suggests a gradient of atherosclerosis between uninfected individuals and patients with CagA-positive H. pylori infection and should prompt research into the role of CagA-positive H. pylori infection in the inflammatory atherosclerotic process.