Association of endothelial dysfunction and cytotoxin-associated gene A-positive Helicobacter pylori in patients with cardiac syndrome X

Existence of coronary endothelial dysfunction has been demonstrated in patients
with cardiac syndrome X (CSX). In addition, Helicobacter pylorus (H. pylori) has been
associated with CSX. We aimed to assess the possible association of endothelial
dysfunction and cytotoxin-associated gene A-positive H. pylori (CagAþ) infection in CSX
patients.
Methods: Fifty-six patients with CSX (23 male/33 female; age: 51.25 ± 8.86 years) who were
anti-H. pylori IgG-positive [H. pylori(þ)] and 24 CSX patients (7 male/17 female; age:
52.79 ± 9.88 years) who were H. pylori(�) were included. Also, anti-H. pylori IgG-positive
patients were determined by the presence of IgG antibody to CagA. Levels of endothelin-1
(ET-1), E-selectin and intercellular adhesion molecule-1 (ICAM-1) were measured.
Results: Endothelial dysfunction biomarkers were higher in H. pylori(þ) than in H. pylori(�)
patients (ET-1: 54.60 ± 25.39 vs. 42.59 ± 18.37 pg/ml, p ¼ 0.04; E-selectin: 42.68 ± 14.26 vs.
31.72 ± 8.26 ng/ml, p ¼ 0.001; ICAM-1: 339.68 ± 135.8 vs. 266.51 ± 125.1 ng/ml, p ¼ 0.02).
Among H. pylori(þ) subjects, 28 cases were CagA(þ) and 28 cases were CagA(�). There were
significant differences in measured levels of E-selectin between CagA(þ) and CagA(�)
groups (48.00 ± 16.37 vs. 37.37 ± 9.37 ng/ml, p ¼ 0.004). For ET-1 and ICAM-1 levels, the
difference between CagA(þ) and CagA(�) was insignificant (p ¼ 0.174 and p ¼ 0.07,
respectively).
Conclusion: High levels of endothelial dysfunction biomarkers are found in CSX patients
with anti-CagA(þ). These findings suggest the infection with CagA(þ) H. pylori strain may
play a role as a risk factor in development of CSX through provocation of endothelial
dysfunction. Therefore, a long term follow up to investigate the outcomes of these patients
is proposed.