Copyright © 2004 by the European Society of Cardiology.
Clinical research
CagA-positive cytotoxic H. pylori strains as a link between plaque instability and atherosclerotic stroke
Internal Medicine and Angiology Department, Catholic University of the Sacred Heart, Rome, Italy
* Correspondence to: Antonio Gasbarrini, MD, Internal Medicine and Angiology Department, Catholic University of Sacred Heart, Gemelli Hospital, Largo Gemelli 8, 00168 Rome, Italy. Tel: +39-335-6873562, +39-6-30154294; Fax: +39-6-35500486
E-mail address: angiologia{at}rm.unicatt.it
Received 26 February 2003; revised 30 September 2003; accepted 7 October 2003
Abstract
Aims Previous studies suggested an association between infection by cytotoxic CagA-positive Helicobacter pylori strains and atherosclerotic stroke. It has been hypothesized that CagA strains could increase the risk for stroke by affecting carotid plaque irregularity. Our aims were: (1) to confirm the association between CagA strains and atherosclerotic stroke, and (2) to assess the association between CagA strains and carotid plaque irregularity.
Methods and results We enrolled 105 consecutive patients affected by atherosclerotic stroke and 130 sex, age, social background-matched controls without relevant vascular diseases. Risk factors for atherosclerotic stroke, H. pylori infection and CagA status were evaluated in all subjects. The presence of plaque instability was evaluated by colour Doppler ultrasound. The prevalence of CagA-positive strains was significantly higher in patients than in controls (adjusted OR 2.99, 95% CI 1.52–5.88, P=0.002). The CagA seropositivity was the only factor independently associated with carotid plaque irregularity (adjusted OR 8.42, 95% CI 1.58–44.64, P=0.004).
Conclusion The evidence of significant associations between CagA-positive H. pylori strains and the presence of carotid plaque instability support their possibleinvolvement in the pathophysiology of atherosclerotic stroke.
Key Words: Stroke • Epidemiology andprevention • Atherosclerosis
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