title: Effect of Helicobacter pylori infection on fibrinogen level in elderly patients with ischaemic heart disease.
abstract: BACKGROUND
  Fibrinogen is an important risk factor for ischaemic heart disease (IHD) (1) and an elevated fibrinogen level has been reported in younger patients infected with Helicobacter pylori (H pylori) infection (2, 3). However, the effect of Helicobacter pylori infection on fibrinogen level in elderly population with IHD is not known. Also in particular the effect on fibrinogen with eradication of Helicobacter pylori has not been previously reported. The aim of this study was to investigate the influence of H pylori on fibrinogen levels in elderly patients with IHD and to assess the effect of eradication therapy on fibrinogen levels.
  
  
  METHODS
  Forty patients over the age of 65 years presenting with symptomatic IHD and an age-matched control group of 21 patients were studied. The 14-C urea breath test was used for detecting H pylori infection. Patients found to be H pylori positive were treated with omeprazole 40 mg daily and amoxicillin 500 mg three times daily for 14 days. Fibrinogen concentration was measured at the beginning of treatment and repeated at 4 weeks after completion of treatment along with the urea breath test in those tested positive for H pylori and fibrinogen level was repeated at 6 weeks in the H pylori negative patients.
  
  
  RESULTS
  The prevalence of H pylori infection was 19/40 (47.5%) in the IHD group and 9/21 (42.8%) in the control group. The median serum fibrinogen level was 4.34 g/l (3.73-6.04 i.q. range) in H Pylori positive patients and 4.86 g/l (3.58-6.11 i.q. range) in H Pylori negative patients in both the IHD and age-matched control group, with no significant difference between the two groups, p = 0.78 (Mann-Whitney test). In the IHD group 27/40 (67.5%) had a fibrinogen level >4.0 g/l compared to 11/21 (52.3%) in the control group. The median fibrinogen level decreased significantly from 5.75g/l (i.q. range 4.39-6.71) to 4.41 g/l (i.q. range 3.80-6.06) after eradication treatment of H pylori in patients with raised fibrinogen levels (p < 0.01).
  
  
  CONCLUSIONS
  The presence of H Pylori infection did not correlate with the presence of IHD, and the fibrinogen level was not raised in the IHD group. However, in elderly patients with H pylori infection, eradication therapy lowered fibrinogen levels in those with elevated (>4.0 g/l) fibrinogen level.
authors.affiliation: Department of Medicine for the Elderly, Derbyshire Royal Infirmary, Derby, United Kingdom. syusuf@mdanderson.org
authors.forename: Syed W
authors.initials: SW
authors.lastname: Yusuf
authors.forename: Radha M
authors.initials: RM
authors.lastname: Mishra
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001944:Breath Tests; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005340:Fibrinogen / Q000378:metabolism*; D016481:Helicobacter Infections / Q000175:diagnosis / Q000503:physiopathology*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D017202:Myocardial Ischemia / Q000097:blood* / Q000382:microbiology; D009853:Omeprazole / Q000627:therapeutic use; D010406:Penicillins / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D004791:Enzyme Inhibitors; D010406:Penicillins; D000658:Amoxicillin; D005340:Fibrinogen; D009853:Omeprazole