Cytotoxin-associated Gene-A-positive Helicobacter pylori strains infection increases the risk of recurrent atherosclerotic stroke.
BACKGROUND
CagA-positive Helicobacter pylori infection has been found to be associated with a first-ever atherosclerotic stroke. The aim of this study was to investigate whether these strains represent an independent risk factor for recurrent atherosclerotic stroke.


METHODS
We performed a longitudinal study of patients with a first-ever large vessels stroke and resulted positive at H. pylori serology. Patients had clinical examination 1 month after the acute event, and were subsequently visited or contacted by telephone up to 3 years at 6-month intervals. Sera obtained at the time of enrollment were frozen and analyzed for the presence of anti-CagA antibodies at the end of the study. The primary outcome event was any fatal or nonfatal stroke after the index stroke.


RESULTS
One hundred seventy H. pylori-positive patients were included (n = 68 CagA positive and n = 102 CagA negative). No significant difference regarding age and other stroke risk factors was detected. According to Kaplan-Meier survival analysis, CagA-positive patients showed a significantly higher risk for stroke recurrence than CagA-negative ones (45.6% vs 17.6%; p < .001). Difference in the rate of recurrent stroke between the two groups persisted after Cox regression analysis taking into account possible confounding factors (hazard ratio = 3.5; 95% CI = 1.9-6.4; p < .001).


CONCLUSIONS
Infection with H. pylori CagA-positive strains increases the risk of recurrent atherosclerotic stroke. Seropositivity determination should be performed in order to identify high-risk patients requiring a strict clinical surveillance, and the possible beneficial effect of eradication therapy should be evaluated.
Diomedi
Marina
M
Clinical Neurology, Department of Neuroscience, Tor Vergata University, Rome, Italy. marina.diomedi@uniroma2.it
Stanzione
Paolo
P
Sallustio
Fabrizio
F
Leone
Giorgia
G
Renna
Antonio
A
Misaggi
Giulia
G
Fontana
Carla
C
Pasqualetti
Patrizio
P
Pietroiusti
Antonio
A
D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D000942:Antigens, Bacterial / Q000096:biosynthesis* / Q000235:genetics; D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology*; D001426:Bacterial Proteins / Q000096:biosynthesis* / Q000235:genetics; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000382:microbiology*; D016480:Helicobacter pylori / Q000235:genetics / Q000502:physiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*
D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C080866:cagA protein, Helicobacter pylori