Helicobacter pylori and cardiovascular disease: update 2019

Many studies have been performed concerning the potential role of Helicobacter pylori (H. pylori) in different extra-gastric diseases. Ischemic heart disease (IHD) remains the leading cause of mortality in developed countries. The traditional cardiovascular risk factors could not predict all cases of IHD. Hence, the scientists explore other potential etiologic factors, especially infections. H. pylori infection has been suspected to have a role in the pathogenesis of atherosclerosis. However, after 25 years from the first description, the role of the bacterium in the pathogenesis of IHD remains controversial and enigmatic. Since H. pylori infection is persistent and stimulates both a local and a systemic immune response that could cause significant changes in the markers of inflammation like cytokines, C-reactive protein, heat shock protein, fibrinogen, triglycerides, high density lipoprotein, it has been supposed that the outcomes of this process are atherosclerosis and a prothrombotic state which eventually leads to IHD. Alternative pathogenic mechanisms have been hypothesized, including the occurrence of molecular antigenicity. This hypothesis supposed that H. pylori could provoke auto-immunity as a result of molecular mimicry. The eradication of H. pylori infection as cardiovascular prevention strategy has been the object of some studies. However, the results are of difficult interpretation. Further studies, especially with a cohort and interventional design, have to be performed to reveal the potential relationship between H. pylori and IHD.