title: Association between infection with Helicobacter pylori and Chlamydia pneumoniae and risk of ischemic stroke subtypes: Results from a population-based case-control study.
abstract: OBJECTIVE
  Helicobacter pylori and Chlamydia pneumoniae have been associated epidemiologically and pathogenetically with coronary atherosclerosis. However, population-based data on chronic infection and stroke are lacking. Therefore, we investigated the association of both bacterial pathogens and ischemic stroke subtypes in a population-based case-control study.
  
  
  METHODS
  Patients with first ischemic stroke in the population-based Erlangen Stroke Project were collected as cases. Neighborhood controls were drawn from the study population, matched for age, sex, and place of residence. IgG antibodies to H pylori were measured by enzyme immunoassay, and IgG antibodies to C pneumoniae were measured by microimmunofluorescence technique. Conditional logistic regression was used. Analyses were stratified for etiologic stroke subtypes according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria.
  
  
  RESULTS
  A total of 145 case and 260 control subjects were included. Chronic H pylori infection was associated with a higher risk of stroke caused by small-artery occlusion (adjusted odds ratio, 3.31; 95% CI, 1.15 to 9.56) and a lower risk of cardioembolic stroke (adjusted odds ratio, 0.21; 95% CI, 0.06 to 0.71). Overall, elevated H pylori as well as elevated C pneumoniae antibodies were not associated with ischemic stroke.
  
  
  CONCLUSIONS
  Our population-based study does not provide evidence of any strong association between the immune response to C pneumoniae as a marker of prior infection and ischemic stroke. Further studies are required to reveal the role of chronic H pylori infection as an independent risk factor for the subgroup small-artery occlusion.
authors.affiliation: Unit for Stroke Research and Public Health Medicine, Department of Neurology, University of Erlangen, Germany. heuschmann@public-health.uni-erlangen.de
authors.forename: P U
authors.initials: PU
authors.lastname: Heuschmann
authors.forename: D
authors.initials: D
authors.lastname: Neureiter
authors.forename: M
authors.initials: M
authors.lastname: Gesslein
authors.forename: B
authors.initials: B
authors.lastname: Craiovan
authors.forename: M
authors.initials: M
authors.lastname: Maass
authors.forename: G
authors.initials: G
authors.lastname: Faller
authors.forename: G
authors.initials: G
authors.lastname: Beck
authors.forename: B
authors.initials: B
authors.lastname: Neundoerfer
authors.forename: P L
authors.initials: PL
authors.lastname: Kolominsky-Rabas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D002545:Brain Ischemia / Q000453:epidemiology*; D016022:Case-Control Studies; D023521:Chlamydophila Infections / Q000453:epidemiology*; D016993:Chlamydophila pneumoniae / Q000276:immunology; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D020521:Stroke / Q000145:classification / Q000453:epidemiology*
chemical_list: D000907:Antibodies, Bacterial; D007074:Immunoglobulin G