Prospective study of Helicobacter pylori seropositivity and cardiovascular diseases in a general elderly populationBMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7090.1317 (Published 03 May 1997) Cite this as: BMJ 1997;314:1317
- Timo E Strandberg, senior lecturera,
- Reijo S Tilvis, professor of geriatricsa,
- Matti Vuoristo, physician in chiefa,
- Magnus Lindroos, consultant in cardiologyc,
- Timo U Kosunen, associate professorb
- a Division of Geriatrics, Department of Medicine, University of Helsinki, Haartmaninkatu 4, FIN-00290 Helsinki, Finland
- b Department of Bacteriology and Immunology, University of Helsinki,
- c Department of Cardiology, Vaasa Central Hospital, Vaasa, Finland
- Correspondence to: Professor Tilvis
- Accepted 15 November 1996
Case-control and cross sectional studies have suggested that chronic infection with Helicobacter pylori is a risk factor for cardiovascular disease.1 2 No prospective studies have examined this association in elderly people–those usually with the highest prevalence of H pylori infection.3
Subjects, methods, and results
We performed a prospective study on people from the Helsinki aging study. From the Helsinki census register random cohorts of people alive in July 1988 and born in 1904, 1909, and 1914 (300 in each group, 11.2% of the total population of 8035) were invited to participate; 795 people were alive and still living in the city of Helsinki. Altogether 144 refused to participate, leaving 651 (81.9%) people to be examined clinically up to April 1990. H pylori IgG, IgA, and IgM antibodies were tested by enzyme immunoassays3 in 624 subjects (repeatibility of the test expressed as intraclass correlation coefficient κ=0.95).
Baseline evaluation included a postal questionnaire, a structured interview conducted by public health nurses, a review of all available patient records, a clinical examination carried out by general practitioners, and laboratory investigations after an overnight fast.
Standard 12 lead resting electrocardiographic data were classified according to the Minnesota code criteria in duplicate. The results of echocardiography have been published elsewhere.4
The presence of disease was based either on data from hospital records or on clinical examination, with special emphasis placed on the diagnostic accuracy for cardiac disease. Subjects were assigned to a group of “healthy elderly” (n=122) if their subjective and objective (according to the examining physicians) health was good or moderate; they did not have hypertension, diabetes, dementia, or symptoms of cardiovascular, cerebrovascular, or pulmonary diseases, cancer, or other disabling diseases; and their history showed normal exercise tolerance.
During the five year follow up 250 subjects died. The principal cause of death was determined from the death certificates by trained nosologists at the Central Statistical Office of Finland.
Data were analysed with bmdp software. The differences in laboratory variables were tested with an analysis of variance in which age and sex were included as covariates. The Cox proportional hazards model served to test the influence of H pylori seropositivity on survival, with age and sex used as covariates.
Among the healthy elderly, 68% were seropositive for H pylori. Seropositivity did not differ significantly in subjects with and without manifest vascular diseases (67% v 71%; difference -4.3%, 95% confidence interval -11.8% to 3.3%).
The prevalence of major electrocardiographic or echocardiographic abnormality in subjects seropositive and seronegative for H pylori was similar. Of the laboratory variables, only the serum concentration of high density lipoprotein cholesterol differed between the 419 seropositive subjects and the 190 seronegative subjects (1.46 mmol/l v 1.55 mmol/l; difference -0.09mmol/l, -0.17 to -0.01; P=0.04).
During the five year follow up, crude mortality was 40% and cardiovascular mortality 20% in the whole series. After age and sex were controlled for, H pylori seropositivity was not related either to all cause or cardiovascular mortality (table 1). As expected, several baseline cardiovascular variables (clinical symptoms and signs, electrocardiographic and echocardiographic abnormalities) significantly predicted mortality–for example, total mortality among subjects with and without major electrocardiographic abnormalities at baseline (47% v 35%; difference 12.7%, 5.1% to 20.7%).
On cross sectional analysis we found no association between H pylori seropositivity and cardiovascular diseases (assessed in several ways) in our 624 elderly subjects. Because H pylori seropositivity did not predict total or cardiovascular mortality during a five year follow up, our results offer no evidence for an association between H pylori infection and coronary heart disease, and they differ from those reported recently in younger subjects.1 2 Our results do not exclude the possibility that chronic H pylori infection acquired early in life may increase the lifelong risk of coronary heart disease. By analogy with serum cholesterol concentration in elderly subjects, controlled intervention studies may be needed to ascertain whether eradicating H pylori infection in certain subgroups is worthwhile.
Funding: Ragnar Ekberg Foundation and Yrjö Jahnsson Foundation, Helsinki, Finland.
Conflict of interest: None.