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Screening for Helicobacter pylori infection in patients with cardiovascular and gastrointestinal disease

Nature Reviews Cardiology volume 21, page 593 (2024)Cite this article

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In the Review by Talasaz et al. (Optimizing antithrombotic therapy in patients with coexisting cardiovascular and gastrointestinal disease. Nat. Rev. Cardiol. https://doi.org/10.1038/s41569-024-01003-3, 2024)1, the authors comprehensively address the clinical challenge of balancing the reduction in the risk of cardiovascular events and the occurrence of spontaneous gastrointestinal bleeding (GIB) with the use of antithrombotic agents in patients with concurrent cardiovascular and gastrointestinal conditions. When discussing strategies to prevent GIB, the authors emphasize the importance of decreasing bleeding risk using proton pump inhibitors and risk stratification to individually tailor the antithrombotic therapy regimen. However, they only briefly touch on Helicobacter pylori infection as a risk factor for GIB. We believe that H. pylori infection warrants deeper scrutiny in patients with cardiovascular and gastrointestinal disease who are receiving antithrombotic agents.

H. pylori is one of the most common chronic infections worldwide, with an estimated global prevalence of 50%, causing gastrointestinal pathology ranging from gastritis to malignancy2. Concurrent H. pylori infection in individuals receiving antithrombotic agents increases the risk of GIB by roughly 1.7-fold with low-dose aspirin and by roughly 8.4-fold with dual antiplatelet therapy3,4. H. pylori infection can be diagnosed non-invasively with a high degree of accuracy2 and at the bedside as part of routine clinical practice during, for example, hospitalization for myocardial infarction5, thereby enabling widespread screening. Notwithstanding individual and regional resistance profiles, first-line therapy with antibiotics and proton pump inhibitors leads to a high degree of H. pylori eradication2. Consequently, H. pylori infection might be an assessable target to reduce the risk of GIB in this patient population, thereby also enabling uninterrupted antiplatelet therapy, both of which could have beneficial effects on subsequent cardiovascular outcomes6.

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References

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Authors and Affiliations

  1. Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden

    Jonatan Wärme, Martin O. Sundqvist & Robin Hofmann

  2. Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden

    Stefan James

  3. Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden

    Stefan James

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  1. Jonatan Wärme
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  2. Martin O. Sundqvist
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  4. Robin Hofmann
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Correspondence to Robin Hofmann.

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Wärme, J., Sundqvist, M.O., James, S. et al. Screening for Helicobacter pylori infection in patients with cardiovascular and gastrointestinal disease. Nat Rev Cardiol 21, 593 (2024). https://doi.org/10.1038/s41569-024-01028-8

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