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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2000 December;41(6):829-33

lingua: Inglese

Ischemic cardiovascular disease and Helicobacter pylori. Where is the link?

Pellicano R., Oliaro E. *, Gandolfo N. **, Aruta E. ***, Mangiardi L. *, Orzan F. *, Bergerone S. *, Rizzetto M., Ponzetto A.

From the Department of Gastro-Hepatology *Department of Cardiology Hospital Molinette, Turin (Italy)
**Cardiology Unit Hospital Mauriziano, Turin (Italy)
***Cardiology Unit Hospital Giovanni Bosco, Turin (Italy)


Coronary ­heart dis­ease (CHD) is the lead­ing ­cause of ­death in west­ern coun­tries. Although sev­er­al ­major ­risk fac­tors ­have ­been iden­ti­fied, ­they ­fail to ­account for all the epi­dem­i­olog­i­cal var­i­ants of the dis­ease, ­thus war­rant­ing ­research ­into nov­el cau­sal ­agents. Cardiovascular dis­eas­es ­have ­long ­been asso­ciat­ed ­with chron­ic infec­tions act­ing ­through the acti­va­tion of inflam­ma­to­ry path­ways, and anti­bi­o­tic ther­a­py has ­been ­shown to pro­duce a dra­mat­ic ­decrease in the ­rate of dis­ease recur­rence in ­patients ­with a his­to­ry of myo­car­dial infarc­tion or ­unstable angi­na. The ­link ­between Helicobacter pylo­ri (H. pylo­ri) infec­tion and CHD, ­first ­described by Mendall et al. in 1994, has ­been the sub­ject of a mul­ti­tude of epi­dem­i­olog­i­cal and clin­i­cal stud­ies; how­ev­er, ­these ­have ­been so het­er­o­ge­ne­ous ­that not two of ­them are ­based on a com­par­able selec­tion of ­patients and ­focused on the ­same ­kind of dis­ease, e.g. ­stable cor­o­nary ­heart dis­ease or ­acute myo­car­dial infarc­tion. Evidence ­from ani­mal stud­ies sup­ports the the­sis ­that H. pylo­ri ­plays an extreme­ly impor­tant ­role in the ­acute ­phase of myo­car­dial infarc­tion: the bac­te­ri­um caus­es plate­let aggre­ga­tion and induc­es pro-coag­u­lant activ­ity in experi­men­tal­ly infect­ed ­mice. H. pylo­ri may ­also con­trib­ute to ath­ero­scler­o­sis ­through an ­auto-­immune pro­cess ­against endo­the­lial ­cells or an ­increased con­cen­tra­tion of homo­cys­teine in the ­blood due to ­decreased lev­els of fol­ic ­acid and cobal­a­min. The ­exact ­role of H. pylo­ri can­not yet be ful­ly ­assessed: ­there is a ­clear and ­present ­need for fur­ther stud­ies ­with appro­pri­ate epi­dem­i­olog­i­cal and clin­i­cal approach­es to inves­ti­gate ­through pros­pec­tive and inter­ven­tion­al ­trial the pos­sible cau­sal rela­tion­ship ­between H. pylo­ri and CHD.

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