title: Association between cerebral ischemia and cytotoxin-associated gene-A-bearing strains of Helicobacter pylori.
abstract: OBJECTIVE
  Studies on Helicobacter pylori infection and risk of ischemic stroke yielded variable results. Infection with more virulent H. pylori strains, such as cytotoxin-associated gene-A (CagA)-bearing strains, may be of particular relevance for ischemic diseases. We investigated whether H. pylori and CagA seropositivity are independent risk factors for cerebral ischemia or its etiologic subtypes.
  
  
  METHODS
  We determined IgG antibodies against H. pylori and CagA protein (enzyme immunoassays) in 190 patients with acute cerebral ischemia and in 229 age- and sex-matched control subjects selected randomly from the general population.
  
  
  RESULTS
  CagA seropositivity was more common in patients (114/190; 60.0%) than in control subjects (99/229; 43.2%; odds ratio, 1.97; 95% CI, 1.33 to 2.91; P<0.001). This result remained significant after adjustment for age, sex, vascular risk factors and diseases, and childhood and adult social status (odds ratio, 1.84; 95% CI, 1.13 to 3.00; P=0.015). Subgroup analyses yielded similar results in all etiologic stroke subtypes. In contrast, H. pylori seropositivity in general was not associated with increased risk of stroke or its etiologic subtypes.
  
  
  CONCLUSIONS
  Our results support the hypothesis of an association between infection with CagA-positive H. pylori strains and acute cerebral ischemia.
authors.affiliation: Department of Neurology, University of Heidelberg, Germany.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Preusch
authors.forename: Armin J
authors.initials: AJ
authors.lastname: Grau
authors.forename: Florian
authors.initials: F
authors.lastname: Buggle
authors.forename: Christoph
authors.initials: C
authors.lastname: Lichy
authors.forename: Jan
authors.initials: J
authors.lastname: Bartel
authors.forename: Carmen
authors.initials: C
authors.lastname: Black
authors.forename: Jochen
authors.initials: J
authors.lastname: Rudi
mesh_terms: D000328:Adult; D000368:Aged; D000942:Antigens, Bacterial / Q000032:analysis* / Q000276:immunology; D001426:Bacterial Proteins / Q000032:analysis* / Q000276:immunology; D002545:Brain Ischemia / Q000097:blood / Q000382:microbiology*; D016022:Case-Control Studies; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000276:immunology / Q000472:pathogenicity*; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000382:microbiology
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D007074:Immunoglobulin G; C080866:cagA protein, Helicobacter pylori