Longo-Mbenza Benjamin, Nsenga Jacqueline Nkondi, Mokondjimobe Etienne, Gombet Thierry, Assori Itoua Ngaporo, Ibara Jean Rosaire, Ellenga-Mbolla Bertrand, Vangu Dieudonné Ngoma, Fuele Simon Mbungu
Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa.
Vasc Health Risk Manag. 2012;6:455-61. doi: 10.2147/VHRM.S28680. Epub 2012 Aug 15.
Helicobacter pylori is now incriminated in the pathogenesis of atherosclerosis.
To examine the importance of H. pylori infection as a cardiovascular disease (CVD) risk factor.
Two hundred five patients (128 with H. pylori infection [HP-seropositive] and 77 without) had a baseline assessment for other potential CVD risk factors and were followed prospectively for 10 years (1999-2008). They were assessed on a monthly basis for the outcomes of carotid plaque, angina pectoris, myocardial infarction, and stroke. In the HP-seropositive group, male sex and quartile 4 for IgG anti-H. pylori antibodies (anti-HP Ab) were correlated with traditional CVD risk factors, stroke, myocardial infarction, and angina pectoris.
At the baseline assessment, the levels of carotid intima-media thickness, blood fibrinogen, total cholesterol, fasting plasma glucose, and uric acid were higher in H. pylori-infected patients than in the uninfected group. Serum HDL-cholesterol was significantly lower in the HP-seropositive group. Men had higher levels of IgG anti-HP Ab, waist circumference, blood pressure, uric acid, and total cholesterol than women. Within the HP-seropositive group, individuals in quartile 4 for IgG anti-HP Ab had higher rates of elevated fibrinogen, diabetes mellitus, low high-density lipoprotein cholesterol, arterial hypertension, and high total cholesterol than those in quartile 1. After adjusting for traditional CVD risk factors, H. pylori infection was the only independent predictor of incident carotid plaque (multivariate odds ratio [OR] = 2.3, 95% confidence interval [CI]: 1.2-7.2; P < 0.0001) and incident acute stroke (multivariate OR = 3.6, 95% CI: 1.4-8.2; P < 0.0001). Within the HP-seropositive group and after adjusting for traditional CVD risk factors, male sex was the only independent predictor of incident angina pectoris (multivariate OR = 3.5, 95% CI: 1.6-16; P < 0.0001), incident acute stroke (multivariate OR = 3.2, 95% CI: 1.4-28; P < 0.0001), and acute myocardial infarction (multivariate OR = 7.2, 95% CI: 3.1-18; P < 0.0001).
Our study provides evidence for an association among known CVD risk factors, carotid plaque, stroke, and H. pylori infection. Among infected individuals, there is a significant association among severity of HP-seropositivity, male sex, and CVD. The eradication of H. pylori infection may therefore reduce the emerging burden of CVD in Africa.
幽门螺杆菌现已被认为与动脉粥样硬化的发病机制有关。
探讨幽门螺杆菌感染作为心血管疾病（CVD）危险因素的重要性。
205例患者（128例幽门螺杆菌感染[幽门螺杆菌血清学阳性]，77例未感染）对其他潜在的心血管疾病危险因素进行了基线评估，并前瞻性随访10年（1999 - 2008年）。每月对他们进行颈动脉斑块、心绞痛、心肌梗死和中风结局的评估。在幽门螺杆菌血清学阳性组中，男性和抗幽门螺杆菌IgG抗体（抗幽门螺杆菌抗体）第4四分位数与传统心血管疾病危险因素、中风、心肌梗死和心绞痛相关。
在基线评估时，幽门螺杆菌感染患者的颈动脉内膜中层厚度、血纤维蛋白原、总胆固醇、空腹血糖和尿酸水平高于未感染组。幽门螺杆菌血清学阳性组的血清高密度脂蛋白胆固醇显著降低。男性的抗幽门螺杆菌IgG抗体、腰围、血压、尿酸和总胆固醇水平高于女性。在幽门螺杆菌血清学阳性组中，抗幽门螺杆菌IgG抗体第4四分位数的个体纤维蛋白原升高、糖尿病、低高密度脂蛋白胆固醇、动脉高血压和高总胆固醇的发生率高于第1四分位数的个体。在调整传统心血管疾病危险因素后，幽门螺杆菌感染是颈动脉斑块发生（多变量优势比[OR]=2.3，95%置信区间[CI]：1.2 - 7.2；P<0.0001）和急性中风发生（多变量OR = 3.6，95%CI：1.4 - 8.2；P<0.0001）的唯一独立预测因素。在幽门螺杆菌血清学阳性组中并调整传统心血管疾病危险因素后，男性是心绞痛发生（多变量OR = 3.5，95%CI：1.6 - 16；P<0.0001）、急性中风发生（多变量OR = 3.2，95%CI：1.4 - 28；P<0.0001）和急性心肌梗死发生（多变量OR = 7.2，95%CI：3.1 - 18；P<0.0001）的唯一独立预测因素。
我们的研究为已知的心血管疾病危险因素、颈动脉斑块、中风和幽门螺杆菌感染之间的关联提供了证据。在感染个体中，幽门螺杆菌血清学阳性的严重程度、男性性别与心血管疾病之间存在显著关联。因此，根除幽门螺杆菌感染可能会减轻非洲心血管疾病新出现的负担。
