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Heart 2000;84:267-271; doi:10.1136/heart.84.3.267
Copyright © 2000 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 2000;84:267-271 ( September )

Cardiovascular medicine

Significant association of cagA positive Helicobacter pylori strains with risk of premature myocardial infarction M Gunna, J C Stephensa, J R Thompsonb, B J Rathboned, N J Samanic

a Department of Medicine and Therapeutics, University of Leicester, Leicester LE2 7LX, UK, b Department of Ophthalmology, University of Leicester, c Department of Cardiology, University of Leicester, Glenfield General Hospital, Groby Road, Leicester LE3 9QP, UK, d Department of Gastroenterology, Leicester Royal Infirmary, Leicester LE1 5WW, UK

Correspondence to: Professor Samani email: njs{at}le.ac.uk

Accepted 8 June 2000

OBJECTIVE---To investigate whether genetic diversity of Helicobacter pylori influences its association with coronary heart disease, and specifically whether the risk is confined to infection with the more virulent strains bearing the cytotoxin associated gene-A (cagA) antigen.
DESIGN AND SETTING---Case-control study in hospital admitting unselected patients with myocardial infarction.
METHODS AND SUBJECTS---Serological status for cagA and H pylori were determined in 342 cases of acute myocardial infarction and 214 population based control subjects free of clinical coronary heart disease.
RESULTS---38.0% of cases and 30.8% of controls were cagA seropositive (odds ratio 1.38, 95% confidence interval (CI) 0.94 to 2.01, p = 0.08). In subjects < 65 years old (153 cases, 153 controls), cagA seropositivity was associated with a 1.80-fold increase (95% CI 1.07 to 3.03, p = 0.02) in myocardial infarction risk, which increased further to 2.25-fold (95% CI 1.12 to 4.53, p = 0.01) in subjects < 55 years. There was no significant association of cagA status with classical coronary heart disease risk factors. H pylori seropositivity was present in 60.2% of cases and 53.7% of controls (odds ratio 1.12, 95% CI 0.83 to 1.51, p = 0.43). H pylori seropositivity was not increased in young cases and did not show any interaction with age.
CONCLUSIONS---The association of chronic H pylori infection with risk of myocardial infarction appears to be restricted to cagA bearing strains. The association is age dependent and stronger in younger subjects. Genetic heterogeneity of H pylori may explain some of the discordant findings with regard to the association of H pylori with coronary heart disease.


Keywords: coronary heart disease; risk factors; Helicobacter pylori

© 2000 by Heart
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