Helicobacter pylori: from the stomach to the heart

A surprising number of extra-gastrointestinal diseases have been reported t o be associated with Helicobacter pylori infection, including coronary hear t disease and stroke. Since coronary heart disease is the principal cause o f death in western countries, and since the known risk factors cannot fully explain the pathogenic mechanisms of the disease, the exploration of the r ole of possible causal agents has stimulated intense research. Infectious a gents have been linked to coronary heart disease on epidemiological and pat hogenic grounds. In 1994, H. pylori infection was reported to be one of the m. Since then, a number of studies have been published with controversial r esults. Studies performed thus far show a high degree of heterogeneity in t he selection of patients and also in the type of disease studied, i.e. coro nary heart disease in general or acute myocardial infarction. Since the pat hogenic development is most likely different for each of these two conditio ns (one chronic and the other acute) they should be studied separately. H. pylori infection can cause platelet aggregation and induces a procoagulant activity. H. pylori carl also contribute to atherosclerosis, through increa sed concentration of homocysteine in the blood, caused by decreased levels of folio acid and cobalamin, or to an autoimmune process. Prospective cohor t studies and interventional trials focusing separately on the chronic and acute phases of coronary heart disease and H. pylori infection should be pe rformed in order to provide firm epidemiological data for a causal relation ship. Eur J Gastroenterol Hepatol 11:1335-1337 (C) 1999 Lippincott Williams & Wilkins.