Effect of Helicobacter pylori infection on the risk of acute coronary syndrome: A systematic review and meta-analysis

Yizhen Fang, Chunming Fan, Huabin Xie, Yizhen Fang, Chunming Fan, Huabin Xie

Abstract

Background: Numerous studies have illustrated the association between Helicobacter pylori (H pylori) infection and acute coronary syndrome (ACS). However, the results are contradictory. Therefore, we conducted the meta-analysis to identify the association between H pylori and ACS.

Methods: We performed a systematic search through electronic databases (Excerpta Medica Database, PubMed, Cochrane Library, and Web of Science). Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with a random effect model. We also carried out the sensitivity analysis and publication bias.

Results: Forty-four eligible studies involving 7522 cases and 8311 controls were included. The pooled result showed that H pylori infection was associated with an increase risk of ACS (OR = 2.03, 95% CI 1.66-2.47). In addition, similar results were obtained in subgroups of study quality, area, human development index, and H pylori detection method. The OR for developing countries was significantly higher than developed countries (OR = 2.58 vs OR = 1.69). Moreover, H pylori with cytotoxin-associated antigen A was also significantly associated with an increase risk of ACS (OR = 2.39, 95% CI 1.21-4.74).

Conclusion: The meta-analysis suggested that H pylori infection was associated with an increased risk of ACS, especially in developing countries. H pylori is easily screened and can be treated with a wide range of drugs. Thus, more high-quality and well-designed studies are needed to confirm whether the treatment of H pylori is an effective way to reduce ACS risk.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
PRISMA flow diagram for study selection. PRISMA = preferred reporting items for systematic reviews and meta-analyses.
Figure 2
Figure 2
Forest plot of the association between Helicobacter pylori infection and acute coronary syndrome. The size of the black square represents the weight of the study in the meta-analysis. The rhombus represents the combined OR. OR = odds ratio.
Figure 3
Figure 3
Forest plot of the association between Helicobacter pylori infection and acute coronary syndrome in the subgroup of study quality. The size of the black square represents the weight of the study in the meta-analysis. The rhombus represents the combined OR. OR = odds ratio.
Figure 4
Figure 4
Forest plot of the association between Helicobacter pylori infection and acute coronary syndrome in the subgroup of geographical location. The size of the black square represents the weight of the study in the meta-analysis. The rhombus represents the combined OR. OR = odds ratio.
Figure 5
Figure 5
Forest plot of the association between Helicobacter pylori infection and acute coronary syndrome in the subgroup of human development index. The size of the black square represents the weight of the study in the meta-analysis. The rhombus represents the combined OR. OR = odds ratio.
Figure 6
Figure 6
Begg funnel plot showing the publication bias analysis.

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