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. 2018 Mar 2;13(3):e0193646.
doi: 10.1371/journal.pone.0193646. eCollection 2018.

Current Helicobacter pylori infection is significantly associated with subclinical coronary atherosclerosis in healthy subjects: A cross-sectional study

Minyoung Lee  1 , Haeri Baek  1   2 , Jong Suk Park  1   3 , Sohee Kim  4 , Chanhee Kyung  1   5 , Su Jung Baik  6 , Byoung Kwon Lee  7 , Jie-Hyun Kim  8 , Chul Woo Ahn  1   3 , Kyung Rae Kim  1 , Shinae Kang  1   3
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Current Helicobacter pylori infection is significantly associated with subclinical coronary atherosclerosis in healthy subjects: A cross-sectional study

Minyoung Lee et al. PLoS One. .

Abstract

Helicobacter pylori is a gastrointestinal pathogen known to be associated with cardiovascular disease (CVD). However, most analyses about the effect of H. pylori infection have been done in patients with a history of CVD but not in healthy subjects. We evaluated the association between H. pylori infection and subclinical atherosclerosis by using cardiac multidetector computed tomography (MDCT) in healthy subjects without previous CVD. From December 2007 to February 2014, 463 subjects who underwent the rapid urease test (CLO test), pulse-wave velocity (PWV) measurement, and MDCT for a self-referred health check-up were enrolled to this study. Helicobacter pylori infection was defined on the basis of CLO test positivity on endoscopic gastric biopsy. Significant coronary artery stenosis was defined as ≥50% stenosis in any of the major epicardial coronary vessel on MDCT. The CLO-positive subjects had a lower high-density lipoprotein-cholesterol (HDL-cholesterol) level compared to the CLO-negative subjects. The incidence of significant coronary stenosis was higher in the CLO-positive group (7.6% vs. 2.9%, P = 0.01). Furthermore, the number of subjects with coronary artery calcium score >0 and log{(number of segments with plaque)+1} were also significantly higher in the CLO-positive group. However, there was no statistical difference in the number of subjects with coronary artery calcium score >100, the prevalence of any plaque nor the plaque characteristics (calcified, mixed, or soft). Pulse-wave velocity (PWV) was neither associated with CLO test positivity. The CLO-positive group was 3-fold more likely to have significant coronary artery stenosis even after adjusting for confounding factors (adjusted odds ratio 2.813, 95% confidence interval 1.051-7.528, P = 0.04). In a healthy population, current H. pylori infection was associated with subclinical but significant coronary artery stenosis. The causal relationship between H. pylori infection and subclinical atherosclerosis in a "healthy" population remains to be investigated in the future.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Schematic diagram and overall flow of study participants.
Abbreviations: CLO test, rapid urease test; cardiac MDCT, cardiac multidetector computed tomography; PWV, pulse-wave velocity; CVD, cardiovascular disease; TFT, thyroid function test; Cr, creatinine; CRP, C-reactive protein; GI medications, gastrointestinal medications.
Fig 2
Fig 2. Odds ratio for significant coronary artery stenosis according to the CLO test.
Logistic regression was used for calculating odds ratios with 95% confidence intervals. The reference group comprised the CLO-negative subjects.

  1. Model 1: Not adjusted

  2. Model 2: adjusted for age and sex

  3. Model 3: adjusted for age, sex, HDL-cholesterol

  4. Model 4: adjusted for age, sex, systolic BP, fasting glucose, HDL-cholesterol, anti-hypertension medication, anti-diabetic medication, lipid lowering agent, anti-platelet agent

Abbreviations: OR, odds ratio; CI, confidence interval; BP, blood pressure; HDL-cholesterol, high density lipoprotein-cholesterol.
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Grants and funding

This work was supported by the National Research Foundation of Korea (NRF, http://www.nrf.re.kr) grant funded by the Korea government Ministry of Science (MSIP) (No. 2014R1A1A3051221). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.