Cytotoxin‐Associated Gene‐A – Positive Helicobacter pylori Strains Infection Increases the Risk of Recurrent Atherosclerotic Stroke

Background: CagA‐positive Helicobacter pylori infection has been found to be associated with a first‐ever atherosclerotic stroke. The aim of this study was to investigate whether these strains represent an independent risk factor for recurrent atherosclerotic stroke. Materials and Methods: We performed a longitudinal study of patients with a first‐ever large vessels stroke and resulted positive at H. pylori serology. Patients had clinical examination 1 month after the acute event, and were subsequently visited or contacted by telephone up to 3 years at 6‐month intervals. Sera obtained at the time of enrollment were frozen and analyzed for the presence of anti‐CagA antibodies at the end of the study. The primary outcome event was any fatal or nonfatal stroke after the index stroke. Results: One hundred seventy H. pylori‐positive patients were included (n = 68 CagA positive and n = 102 CagA negative). No significant difference regarding age and other stroke risk factors was detected. According to Kaplan‐Meier survival analysis, CagA‐positive patients showed a significantly higher risk for stroke recurrence than CagA‐negative ones (45.6% vs 17.6%; p < .001). Difference in the rate of recurrent stroke between the two groups persisted after Cox regression analysis taking into account possible confounding factors (hazard ratio = 3.5; 95% CI = 1.9–6.4; p < .001). Conclusions: Infection with H. pylori CagA‐positive strains increases the risk of recurrent atherosclerotic stroke. Seropositivity determination should be performed in order to identify high‐risk patients requiring a strict clinical surveillance, and the possible beneficial effect of eradication therapy should be evaluated.