BMJ 1999;319:1157-1162 ( 30 October )

Papers

Helicobacter pylori infection and early onset myocardial infarction: case-control and sibling pairs study

John Danesh, Merton College junior research fellow,  Linda Youngman, senior research fellow,  Sarah Clark, research fellow,  Sarah Parish, senior research fellow,  Richard Peto, professor of medical statistics and epidemiology,  Rory Collins, British Heart Foundation professor of medicine and epidemiology, 

Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Clinical Medicine, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE

Correspondence to: J Danesh john.danesh{at}balliol.ox.ac.uk

Objectives: To examine the association between coronary heart disease and chronic Helicobacter pylori infection.
Design: Case-control study of myocardial infarction at young ages and study of sibling pairs with one member affected and the other not.
Setting: United Kingdom.
Participants: 1122 survivors of suspected acute myocardial infarction at ages 30-49 (mean age 44 years) and 1122 age and sex matched controls with no history of coronary heart disease; 510 age and sex matched pairs of siblings (mean age 59 years) in which one sibling had survived myocardial infarction and one had no history of coronary heart disease.
Main outcome measures: Serological evidence of chronic infection with H pylori.
Results: 472 (42%) of the 1122 cases with early onset myocardial infarction were seropositive for H pylori antibodies compared with 272 (24%) of the 1122 age and sex matched controls, giving an odds ratio of 2.28 (99% confidence interval 1.80 to 2.90). This odds ratio fell to 1.87 (1.42 to 2.47; P<0.0001) after smoking and indicators of socioeconomic status were adjusted for and to 1.75 (1.29 to 2.36) after additional adjustment for blood lipid concentrations and obesity. Only 158 of the 510 pairs of siblings were discordant for H pylori status; among these, 91 cases and 67 controls were seropositive (odds ratio 1.33 (0.86 to 2.05)). No strong correlations were observed between H pylori seropositivity and measurements of other risk factors for coronary heart disease (plasma lipids, fibrinogen, C reactive protein, albumin, etc).
Conclusion: In the context of results from other relevant studies, these two studies suggest a moderate association between coronary heart disease and H pylori seropositivity that cannot be fully accounted for by other risk factors. But even if this association is causal and largely reversible by eradication of chronic infection, very large randomised trials would be needed to show this.


Key messages

  • Most previous studies of associations between chronic H pylori infection and coronary heart disease have been too small or prone to bias

  • This case-control study found myocardial infarction was twice as common in people infected with H pylori as in those not infected

  • Among sibling pairs, myocardial infarction was about a third more common in seropositive people than those who were seronegative

  • These results support a weak association between H pylori infection and coronary heart disease




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Reported odds are for being H pylori positive, not for having an infarction
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