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(Stroke. 2004;35:1800.)
© 2004 American Heart Association, Inc.

Original Contributions

Association Between Cerebral Ischemia and Cytotoxin-Associated Gene-A–Bearing Strains of Helicobacter pylori

Michael R. Preusch; Armin J. Grau, MD, PhD; Florian Buggle, MD; Christoph Lichy, MD; Jan Bartel, MD; Carmen Black, MD Jochen Rudi, MD, PhD

From the Department of Neurology (M.R.P., F.B., C.L.), University of Heidelberg; Department of Neurology (A.J.G.), Klinikum Ludwigshafen; Limbach Laboratory Heidelberg (J.B., C.B.); and the Department of Gastroenterology (J.R.), Theresienkrankenhaus und St. Hedwig-Klinik, Mannheim, Germany.

Correspondence to Dr Armin J. Grau, Department of Neurology, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstrasse 79, 67063 Ludwigshafen, Federal Republic of Germany. E-mail graua{at}klilu.de

Background and Purpose— Studies on Helicobacter pylori infection and risk of ischemic stroke yielded variable results. Infection with more virulent H. pylori strains, such as cytotoxin-associated gene-A (CagA)–bearing strains, may be of particular relevance for ischemic diseases. We investigated whether H. pylori and CagA seropositivity are independent risk factors for cerebral ischemia or its etiologic subtypes.

Methods— We determined IgG antibodies against H. pylori and CagA protein (enzyme immunoassays) in 190 patients with acute cerebral ischemia and in 229 age- and sex-matched control subjects selected randomly from the general population.

Results— CagA seropositivity was more common in patients (114/190; 60.0%) than in control subjects (99/229; 43.2%; odds ratio, 1.97; 95% CI, 1.33 to 2.91; P<0.001). This result remained significant after adjustment for age, sex, vascular risk factors and diseases, and childhood and adult social status (odds ratio, 1.84; 95% CI, 1.13 to 3.00; P=0.015). Subgroup analyses yielded similar results in all etiologic stroke subtypes. In contrast, H. pylori seropositivity in general was not associated with increased risk of stroke or its etiologic subtypes.

Conclusions— Our results support the hypothesis of an association between infection with CagA-positive H. pylori strains and acute cerebral ischemia.

Key Words: stroke • risk factors • infection • inflammation

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