Effects of Helicobacter pylori eradication on platelet activation and disease recurrence in patients with acute coronary syndromes.
BACKGROUND
Platelet activation is consistently observed in animal models of Helicobacter pylori infection and could help to explain the alleged epidemiological association between H. pylori and coronary heart disease.


METHODS
Ninety-two patients with recent acute coronary syndromes were enrolled. Helicobacter pylori-positive patients were randomized to receive a 7-day course of omeprazole, amoxycillin and metronidazole or placebos. Two months later, H. pylori status was reassessed and baseline parameters, including soluble P-selectin and platelet surface expression of CD62P, CD63 and CD41, were measured again. Patients were followed-up for 1 year or until death or readmission.


RESULTS
No baseline differences were observed between H. pylori-positive and -negative cases. Among H. pylori-positive patients, 18 received placebo and 31 received active medication resulting in eradication in 21 cases. No differences were observed in inflammatory parameters or platelet activation markers between patients with persistent or resolved H. pylori infection. However, coronary events recurred at 6 and 12 months, respectively, in 35% and 55% of patients with persisting H. pylori infection compared with 10% and 25% of patients in whom H. pylori was either absent or eradicated (p = .01). Only final H. pylori status [RR 3.07 (95% CI 1.35-98)] and number of coronary risk factors [RR 2.58 (95% CI 1.51-4.41)] were independent predictors of recurrence.


CONCLUSIONS
Infection with H. pylori does not induce significant platelet activation in patients treated for coronary disease. Helicobacter pylori-infected patients, however, may have an increased risk of recurrence of coronary events.
Elizalde
J Ignasi
JI
Gastroenterology Department, Institut Clínic de Malalties Digestives, University of Barcelona, Barcelona, Spain.
Pérez-Pujol
Sílvia
S
Heras
Magda
M
Sionis
Alessandro
A
Casanovas
Núria
N
Martorell
Teresa
T
Lozano
Miquel
M
González
Julián
J
Escolar
Ginés
G
Sanz
Ginés
G
Piqué
Josep M
JM
D000208:Acute Disease; D000658:Amoxicillin / Q000627:therapeutic use; D015703:Antigens, CD / Q000032:analysis; D003327:Coronary Disease / Q000150:complications* / Q000503:physiopathology; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy; D016480:Helicobacter pylori / Q000187:drug effects / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D019007:P-Selectin / Q000032:analysis; D015539:Platelet Activation; D040201:Platelet Membrane Glycoprotein IIb / Q000032:analysis; D010980:Platelet Membrane Glycoproteins / Q000032:analysis; D012008:Recurrence; D060149:Tetraspanin 30
D015703:Antigens, CD; C554586:CD63 protein, human; D019007:P-Selectin; D040201:Platelet Membrane Glycoprotein IIb; D010980:Platelet Membrane Glycoproteins; D060149:Tetraspanin 30; D008795:Metronidazole; D000658:Amoxicillin; D009853:Omeprazole