Published Online
on May 27, 2004

A more recent version of this article appeared on August 1, 2004

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Submitted on October 15, 2003
Revised on April 6, 2004
Accepted on April 14, 2004

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; and 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.

^* To whom correspondence should be addressed. 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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