Abstract
Numerous studies have shown that Helicobacter pylori (HP) infection may be involved in the development of carotid atherosclerosis (CAS), but this conclusion is still controversial. The aim of this study was to explore whether there is a positive association between HP infection and CAS occurrence. We collected data on demographic characteristics, lifestyle, and disease history of the participants by questionnaire. We obtained clinical anthropometric data and blood samples of the participants from clinical examinations and laboratory work. The 13C urea breath test (13C-UBT) was performed to assess the HP infection status, and carotid ultrasonography was used to diagnose the CAS and plaque types. Univariate analysis and multivariate logistic regression were used to identify the relationship between HP infection and CAS. A total of 1,424 participants were recruited for this study. A total of 740 HP-positive individuals and 684 HP-negative individuals were identified, and 345 participants were diagnosed with CAS. The prevalence of CAS was higher in the HP-positive group (26.4%) than in the HP-negative group (21.7%) (P < 0.05). A significantly higher prevalence of carotid intima-media thickening, carotid plaque, and carotid stenosis was identified in the HP-positive group than in the HP-negative group (P < 0.05). There was no significant difference in the detection rate of unstable plaques between the HP-positive and HP-negative groups (P > 0.05). In multivariate models adjusted for covariates, HP infection showed a positive association with CAS, independent of other risk factors (ORs range: 1.283–1.333, P < 0.05). HP infection independently accounted for approximately 5% of the CAS risk in the absence of other cardiovascular risk factors. A positive association between HP infection and CAS was demonstrated in this study. HP infection might be an independent risk factor for CAS. Although the effect of HP infection on CAS observed in our study was less than that of traditional risk factors, we believe that this is an indispensable advance in the etiological study of CAS. These results imply that the microbial population might play an essential role in CAS, which provides a new perspective for the primary prevention of CAS.
Highlights
The increasing prevalence of carotid atherosclerosis (CAS) and cardio-cerebrovascular diseases (CVDs) in middle-aged adults and seniors imposes a heavy disease burden on society
We analyzed the difference in the mean value or rate of each characteristic between the Helicobacter pylori (HP)-positive and HP-negative groups by t-test, rank sum test, or χ2 test We used logistic regression analysis to examine the association between CAS and HP infection, and multivariate regression models were adjusted for covariates
We found a positive association between HP infection and each type of CAS; the HP-positive group had a higher prevalence of carotid intima-media thickening, carotid plaque, and carotid stenosis than the HP-negative group, and the difference was statistically significant (12.3 vs. 8.8%, 7.6 vs. 4.5%, 24.3 vs. 18.7%, P < 0.05) (Figure 5A)
Summary
The increasing prevalence of carotid atherosclerosis (CAS) and cardio-cerebrovascular diseases (CVDs) in middle-aged adults and seniors imposes a heavy disease burden on society. CAS is characterized by endothelial injury and lipid deposition in carotid arteries, accompanied by thrombosis, fibrous tissue hyperplasia, and calcinosis, which can develop into atherosclerotic plaques [1]. Plaque thickening can eventually lead to vascular occlusion and trigger ischemic cerebrovascular accidents (CVAs). Past studies have explored the causes of atherogenesis, the results remain incomplete. Classic risk factors, such as age, sex, smoking, blood pressure, diabetes, high-density lipoprotein-cholesterol (HDL-cholesterol), and certain medications, account for 19.5% of the total plaque area burden [2]. Identifying potential risk factors for CAS that are unexplained by traditional risk factors might improve the preventive strategies
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