Assessment of Helicobacter pylori Infection as a Risk Factor for Coronary Artery Disease in Gaza Strip

Abstract

Background: Coronary artery disease (CAD) is a common form of cardiovascular disease (CVD). It caused by atherosclerosis, which restricts blood flow to the heart, and when the blood flow completely cut off, the result is heart attack. Cardiovascular disease remains the leading cause of death in the world as well as in Palestine. Helicobacter pylori (H. pylori) infection believed to be associated with CAD. Objective: Assessment of H. pylori infection as a risk factor for CAD in Gaza strip. Material and methods: This case-control study comprised 62 CAD patients (Cases: 31 males and 31 females) and 62 healthy controls (31 males and 31 females). Questionnaire interview was applied. Blood samples were collected, processed and analyzed. Serum H. pylori IgG, cholesterol, triglycerides, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), creatinine phosphokinase (CK) and creatinine phosphokinase MB (CKMB) were determined. White blood cell (WBC), red blood cell (RBC), hemoglobin (Hb) and platelet (PLT) were also determined. Data were analyzed using SPSS version 18.0. Results: Coronary artery disease was more prevalent among less educated and unemployed individuals, families with low income, individuals with family history of the disease as well as among smokers. The number of cases who had diabetes mellitus, hypertension and peptic ulcer was significantly higher than that of controls. The BMI was significantly higher in cases compared to controls (31.7±4.8 vs 27.6±4.4, % difference=13.8 and P=0.000). There were significant elevations in the activities of serum AST and LDH in cases compared to controls (36.3±24.5 and 540.8±310.7 U/L vs 18.6±6.0 and 321.3±66.1 U/L, % difference=64.5 and 50.9, respectively P=0.000). Similarly CK and CKMB activities were higher in cases (225.7±216.1 and 22.7±15.5 U/L vs 101.2±50.0 and 11.4±4.9 U/L, % difference=76.2 and 67.8, respectively P=0.000). The levels of cholesterol, triglycerides and LDL-C were found to be higher in cases (208.9±47.6, 218.0±110.1 and 131.6±41.9 mg/dl, respectively) compared to controls (174.8±34.1, 167.4±57.7 and 104.4±31.2 mg/dl, % differences of 17.8%, 26.3%, and 23.1 and P=0.000, P=0.001, P=0.000 respectively). On the other hand, the level of HDL-C was significantly lower in cases (33.7±9.8 vs 37.6±8.4 mg/dl, % difference=10.9, P=0.020). The WBC count was significantly higher in cases compared to controls (9.80±3.3 vs 7.8±1.6 ×109/L, % difference 22.7, P=0.000), whereas RBC count, hemoglobin content and PLT count did not show significant differences between cases and controls (P>0.05). The prevalence of H. pylori among CAD patients 46 (74.2%) was significantly higher than controls 26 (41.9%) with P=0.000. When related to H. pylori, serum triglycerides was significantly increased in H. pylori positive cases more than in negative cases (235.8±112.8 vs 166.6±85.7mg/dl, P=0.029), whereas HDL-C level was significantly lower in positive cases (31.7±8.0 vs 39.5±12.3 mg/dl, P=0.005). The WBC count was significantly higher in positive compared to negative cases (10.5± 3.5 vs 7.9±2.1 P=0.007). Conclusions: H. pylori infection was significantly higher in CAD patients compared to controls. H. pylori infection was associated with higher triglyceride levels and WBC count, and lower HDL-C levels, and. Therefore, monitoring of H. pylori infection as a possible risk factor of coronary artery disease is of clinical value.