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NEUROLOGY 2004;63:800-804
© 2004 American Academy of Neurology

CagA-positive Helicobacter pylori strains may influence the natural history of atherosclerotic stroke

M. Diomedi, MD, PhD, A. Pietroiusti, MD, M. Silvestrini, MD, B. Rizzato, MD, L. M. Cupini, MD, F. Ferrante, MD, A. Magrini, MD, A. Bergamaschi, MD, A. Galante, MD and G. Bernardi, MD

From the Neurological Clinic (Drs. Diomedi, Rizzato, Cupini, Ferrante, and Bernardi), Medical Semiology and Methodology (Drs. Pietroiusti and Galante), and Occupational Medicine (Drs. Magrini and Bergamaschi), Tor Vergata University, Rome, Italy; Fondazione Santa Lucia IRCCS (Drs. Diomedi, Rizzato, and Bernardi), Rome, Italy; Clinica San Raffaele (Drs. Pietroiusti and Galante), Tosinvest Sanità, Rome, Italy; and Neurological Clinic (Dr. Silvestrini), University of Ancona, Italy.

Address correspondence and reprint requests to Dr. Marina Diomedi, Clinica Neurologica, Policlinico Tor Vergata, Viale Oxford, 81-00133 Rome, Italy; e-mail: Marina.Diomedi{at}uniroma2.it

Objective: To test the hypothesis that infection with virulent cytotoxin-associated gene-A (CagA)-bearing Helicobacter pylori strains influences the atherosclerotic process and the clinical course in atherosclerotic stroke patients.

Methods: ELISA was used to assess the seroprevalence of infection by H. pylori and CagA-positive strains in 185 patients. Intima-media thickness (IMT) was determined by Doppler ultrasound. Baseline, 1-week, and 1-month NIH Stroke Scale (NIHSS) scores were used to evaluate the short-term clinical course.

Results: H. pylori infection was found in 79% of patients; 58% of these tested positive for CagA. IMT was higher among CagA-positive patients than among CagA-negative ones (1.13 ± 0.26 mm vs 0.97 ± 0.15 mm; univariate analysis, p = 0.0001; multivariate analysis, odds ratio [OR], 2.36; 95% CI, 1.57 to 3.54; p = 0.0001) or H. pylori-negative ones (1.01 ± 0.17 mm; univariate analysis, p = 0.007; multivariate analysis, OR, 1.90; 95% CI, 1.22 to 2.97; p = 0.005). CagA-positive patients had poorer initial outcomes based on serial measurements of the NIHSS score (repeated measures analysis of variance, p < 0.0001). No significant difference in IMT and NIHSS score was found between H. pylori-positive and H. pylori-negative patients.

Conclusions: Infection with cytotoxin-associated gene-A-positive Helicobacter pylori strains in atherosclerotic stroke patients is associated with greater intima-media thickness and poorer short-term outcome compared with cytotoxin-associated gene-A-negative patients.

Received September 5, 2003. Accepted in final form January 26, 2004.




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