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Helicobacter pylori, Inflammation, and Long-Term Outcome in Patients With Acute Myocardial Infarction : A Prospective Cohort Study

Sundqvist, Martin O. ; Wärme, Jonatan ; Hjort, Marcus ; Tornvall, Per ; Jernberg, Tomas ; Lindahl, Bertil ; Schiopu, Alexandru LU orcid ; Baron, Tomasz ; Jacobson, Stefan H. and Kahan, Thomas , et al. (2026) In Helicobacter 31(2).
Abstract

Background: Helicobacter pylori (Hp) and its virulence factor Cytotoxin-associated gene A (CagA) have been linked to myocardial infarction (MI), but the mechanisms are unknown. This study aims to test if Hp infection and CagA are associated with pre-specified inflammatory and vascular biomarkers in patients with MI and to explore whether a broader biomarker panel can predict infection. Furthermore, it aims to investigate the association of Hp infection and biomarkers with major adverse cardiovascular events (MACE) and mortality. Materials and Methods: Hp, CagA serology, and 175 cardiovascular biomarkers were analyzed in 1061 patients with MI admitted between 2008 and 2014. Associations between Hp and seven pre-selected biomarkers were... (More)

Background: Helicobacter pylori (Hp) and its virulence factor Cytotoxin-associated gene A (CagA) have been linked to myocardial infarction (MI), but the mechanisms are unknown. This study aims to test if Hp infection and CagA are associated with pre-specified inflammatory and vascular biomarkers in patients with MI and to explore whether a broader biomarker panel can predict infection. Furthermore, it aims to investigate the association of Hp infection and biomarkers with major adverse cardiovascular events (MACE) and mortality. Materials and Methods: Hp, CagA serology, and 175 cardiovascular biomarkers were analyzed in 1061 patients with MI admitted between 2008 and 2014. Associations between Hp and seven pre-selected biomarkers were evaluated. Exploratory analyses included all biomarkers using machine-learning models to predict Hp-status. Hp-status and the top predictors were analyzed for associations with outcomes using Cox regression. Results: Median age was 65 years; 78% were male. Hp and CagA seroprevalence were 45% and 19%, respectively. Patients with Hp had elevated CRP (β = 0.26, 95% CI 0.01–0.51). Predictive performance of Hp-status was moderate (AUC 0.63–0.68). Exploratory analysis identified higher levels of C-C motif chemokine ligand 20 (CCL20) and immunoglobulin heavy constant gamma-3 (IGHG3), and lower levels of TNF-related apoptosis-inducing ligand (TRAIL) in patients with Hp-positivity. Elevated CCL20 and reduced TRAIL, but not Hp, were associated with MACE and all-cause mortality. Conclusions: Hp may contribute to an inflammatory response in patients with MI, indicated by higher CRP and inflammatory/immune-modulatory biomarkers emerging as its top predictors. Although Hp was not associated with adverse outcomes after MI, its predictive inflammatory biomarkers were associated with MACE and mortality. Trial Registration: The study was not registered as a clinical trial, as it was an observational study.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
biomarkers, coronary heart disease, Helicobacter pylori, inflammation, myocardial infarction
in
Helicobacter
volume
31
issue
2
article number
e70116
publisher
Wiley-Blackwell
external identifiers
  • scopus:105032877005
  • pmid:41834132
ISSN
1083-4389
DOI
10.1111/hel.70116
language
English
LU publication?
yes
id
174cd9ac-8beb-445b-a664-9bee11b72b99
date added to LUP
2026-04-22 11:45:31
date last changed
2026-05-06 12:35:51
@article{174cd9ac-8beb-445b-a664-9bee11b72b99,
  abstract     = {{<p>Background: Helicobacter pylori (Hp) and its virulence factor Cytotoxin-associated gene A (CagA) have been linked to myocardial infarction (MI), but the mechanisms are unknown. This study aims to test if Hp infection and CagA are associated with pre-specified inflammatory and vascular biomarkers in patients with MI and to explore whether a broader biomarker panel can predict infection. Furthermore, it aims to investigate the association of Hp infection and biomarkers with major adverse cardiovascular events (MACE) and mortality. Materials and Methods: Hp, CagA serology, and 175 cardiovascular biomarkers were analyzed in 1061 patients with MI admitted between 2008 and 2014. Associations between Hp and seven pre-selected biomarkers were evaluated. Exploratory analyses included all biomarkers using machine-learning models to predict Hp-status. Hp-status and the top predictors were analyzed for associations with outcomes using Cox regression. Results: Median age was 65 years; 78% were male. Hp and CagA seroprevalence were 45% and 19%, respectively. Patients with Hp had elevated CRP (β = 0.26, 95% CI 0.01–0.51). Predictive performance of Hp-status was moderate (AUC 0.63–0.68). Exploratory analysis identified higher levels of C-C motif chemokine ligand 20 (CCL20) and immunoglobulin heavy constant gamma-3 (IGHG3), and lower levels of TNF-related apoptosis-inducing ligand (TRAIL) in patients with Hp-positivity. Elevated CCL20 and reduced TRAIL, but not Hp, were associated with MACE and all-cause mortality. Conclusions: Hp may contribute to an inflammatory response in patients with MI, indicated by higher CRP and inflammatory/immune-modulatory biomarkers emerging as its top predictors. Although Hp was not associated with adverse outcomes after MI, its predictive inflammatory biomarkers were associated with MACE and mortality. Trial Registration: The study was not registered as a clinical trial, as it was an observational study.</p>}},
  author       = {{Sundqvist, Martin O. and Wärme, Jonatan and Hjort, Marcus and Tornvall, Per and Jernberg, Tomas and Lindahl, Bertil and Schiopu, Alexandru and Baron, Tomasz and Jacobson, Stefan H. and Kahan, Thomas and Erlinge, David and Spaak, Jonas and Hofmann, Robin}},
  issn         = {{1083-4389}},
  keywords     = {{biomarkers; coronary heart disease; Helicobacter pylori; inflammation; myocardial infarction}},
  language     = {{eng}},
  number       = {{2}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Helicobacter}},
  title        = {{Helicobacter pylori, Inflammation, and Long-Term Outcome in Patients With Acute Myocardial Infarction : A Prospective Cohort Study}},
  url          = {{http://dx.doi.org/10.1111/hel.70116}},
  doi          = {{10.1111/hel.70116}},
  volume       = {{31}},
  year         = {{2026}},
}