Prevalence of Helicobacter pylori infection in coronary artery disease andeffect of its eradication on coronary lumen reduction after percutaneous coronary angioplasty

Background. Gastric infection caused by Helicobacter pylori has recently be en associated with increased risk of coronary artery disease. Aim. To: 1) determine seroprevalence of Helicobacter pylori and its cytotox in associated gene A in patients with/without coronary artery disease (grou p A), 2) assess influence of Helicobacter pylori eradication on coronary ar tery lumen reduction after percutaneous coronary angioplasty (group B) and 3) determine influence of Helicobacter pylori eradication on plasma cytokin es, lipids and coagulation factors in patients subjected to percutaneous co ronary angioplasty (group B). Patients and methods. Group A included 100 patients with coronary artery di sease (subgroup I) and 100 patients without (subgroup II). For Helicobacter pylori seroprevalence, plasma anti-Helicobacter pylori and anti-cytotoxin associated gene A IgG were examined. Group B included 40 patients with sign ificant single-vessel coronary arterial disease and Helicobacter pylori inf ection confirmed by C-13-urea breath test and serologically using anti-Heli cobacter pylori and anti-cytotoxin associated gene A IgG. Six months after percutaneous coronary angioplasty and triple anti-Helicobacter pylori thera py, the Helicobacter pylori status reassessed by urea breath test was negat ive in all but two patients of subgroup I subjected to Helicobacter pylori therapy. Coronary angiography and laboratory tests were repeated in both su bgroups of group B included in the trial and reduction in coronary artery l umen in these subgroups was compared to baseline after percutaneous coronar y angioplasty considered as 100%. Results. Helicobacter pylori seropositivity reached 81.5% of coronary arter y disease (subgroup II and was significantly higher than that in controls w ithout coronary artery disease (subgroup II) (51%), the adds ratio being 4. 3 for Helicobacter pylori in coronary artery disease. Cytotoxin associated gene A IgG detection was also significantly higher (47.3%) in coronary arte ry disease than in controls (28%) giving the odds ratio about 2. 3. Mean co ronary artery lumen reduction in patients undergoing percutaneous coronary angioplasty + Helicobacter pylori eradication therapy (subgroup I) was sign ificantly (p <0.05) smaller compared to percutaneous coronary angioplasty placebo-treated subgroup II (22% vs 41%). Conclusions. 1) There is a significant link between coronary artery disease and infection with Helicobacter pylori, especially expressing CagA protein s, 2) Helicobacter pylori eradication significantly attenuates reduction in coronary artery lumen in coronary artery disease patients after percutaneo us coronary angioplasty possibly by elimination of chronic inflammation and decline in proinflammatory cytokine release, and 3) Infection of Chlamydia pneumoniae in these percutaneous coronary angioplasty patients is not affe cted by eradication therapy.