Elevated hsCRP levels signal increased risk of future cardiovascular disease independent of lipid profile in H. pylori infection

Gaurav Shashikant Kansara, Pooja Nitin Joshi, Shyam Rameshwar Adhau


Background:There are reports that Helicobacter pylori (H. pylori) infection leads to changes in serum lipid profile and high sensitivity C-reactive protein (hsCRP) levels, but role of H. pylori in causing increased risk of cardiovascular disease remains a topic of debate.

Methods:A case control study was conducted, in subjects without pre-existing atherosclerotic disease. We studied 72 otherwise healthy subjects in the age group of 20 to 60 years. All subjects underwent gastroduodenoscopy and H. pylori infection status was assessed by rapid urease test.

Results:There were no statistical differences in serum total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol levels or total cholesterol/HDL cholesterol ratios between cases and controls. However, serum hsCRP (high sensitivity C-reactive protein) levels were significantly higher in cases as compared to controls (P <0.05).

Conclusion:The results of this study showed that H. pylori infection does not modify serum lipid levels; however, it leads to a rise in hsCRP, an important risk factor for atherosclerosis. It can be concluded that H. pylori infection may contribute to atherogenesis through the state of chronic inflammation, which is evidenced by elevated hsCRP levels.



Helicobacter pylori, Cholesterol, HDL cholesterol, LDL cholesterol, Triglyceride, C-reactive protein

Full Text:



Graham DY, Adam E, Reddy GT, Agarwal JP, Agarwal R, Evans DJ Jr, et al. Seroepidemiology of Helicobacter pylori infection in India. Comparison of developing and developed countries. Dig Dis Sci. 1991 Aug;36(8):1084-8.

Mancini GB, Dahlöf B, Díez J. Surrogate markers for cardiovascular disease: structural markers. Circulation. 2004 Jun;109(25 Suppl 1):IV22-30.

Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002 Nov;347(20):1557-65.

Strachan DP, Mendall MA, Carrington D, Butland BK, Yarnell JW, Sweetnam PM, et al. Relation of Helicobacter pylori infection to 13-year mortality and incident ischemic heart disease in the Caerphilly prospective heart disease study. Circulation. 1998 Sep;98(13):1286-90.

Zuberi BF, Shaikh SA, Shaikh WM, Shaikh GM, Jatoi N. IgG antibodies against H. pylori in patients of myocardial infarction. J Coll Physicians Surg Pak. 1998;8(6):249-51.

Laurila A, Bloigu A, Nayha S, Hassi J, Leinonen M, Saikku P. Association of Helicobacter pylori infection with elevated serum lipids. Atherosclerosis. 1999;142:207-10.

Hoffmeister A, Rothenbacher D, Bode G, Persson K, März W, Nauck MA, et al. Current infection with Helicobacter pylori, but not seropositivity to Chlamydia pneumoniae or cytomegalovirus, is associated with an atherogenic, modified lipid profile. Arterioscler Thromb Vasc Biol. 2001 Mar;21(3):427-32.

Chimienti G, Russo F, Lamanuzzi BL, Nardulli M, Messa C, Di Leo A, et al. Helicobacter pylori is associated with modified lipid profile: impact on lipoprotein(a). Clin Biochem. 2003 Jul;36(5):359-65.

Kanbay M, Gür G, Yücel M, Yilmaz U, Boyacioğlu S. Does eradication of Helicobacter pylori infection help normalize serum lipid and CRP levels? Dig Dis Sci. 2005 Jul;50(7):1228-31.

Longo-Mbenza B, Nkondi Nsenga J, Vangu Ngoma D. Prevention of the metabolic syndrome insulin resistance and the atherosclerotic diseases in Africans infected by Helicobacter pylori infection and treated by antibiotics. Int J Cardiol. 2007 Oct;121(3):229-38.

Ishida Y, Suzuki K, Taki K, Niwa T, Kurotsuchi S, Ando H, et al. Significant association between Helicobacter pylori infection and serum C-reactive protein. Int J Med Sci. 2008 Jul;5(4):224-9.

Ugwuja EI, Ugwu NC. Plasma lipids in Helicobacter pylori infected pregnant women. Int J Med Med Sci. 2009 May;1(5):224-6.

Jia EZ, Zhao FJ, Hao B, Zhu TB, Wang LS, Chen B, et al. Helicobacter pylori infection is associated with decreased serum levels of high density lipoprotein, but not with the severity of coronary atherosclerosis. Lipids Health Dis. 2009 Dec;23(8):59.

Ansari MHK, Omrani M, Sayyah B, Ansari SK. Effect of Helicobacter pylori infection on the lipid, lipoproteins, apolipoprotein-A1, lipoprotein (a) and apolipoprotein-B in patients with gastritis. Afr J Microbiol Res. 2010 Jan;4(1):84-7.

Gen R, Demir M, Ataseven H. Effect of Helicobacter pylori eradication on insulin resistance, serum lipids and low-grade inflammation. South Med J. 2010 Mar;103(3):190-6.

Kebapcilar L, Bilgir O, Cetinkaya E, Akyol M, Bilgir F, Bozkaya G. The effect of Helicobacter pylori eradication on macrophage migration inhibitory factor, C-reactive protein and fetuin-a levels. Clinics (Sao Paulo). 2010 Jun;65(8):799-802.

Akbas HS, Basyigit S, Suleymanlar I, Kemaloglu D, Koc S, Davran F, et al. The assessment of carotid intima media thickness and serum paraoxonase-1 activity in Helicobacter pylori positive subjects. Lipids Health Dis. 2010 Aug;9:92.

Jalalzadeh M, Saber HR, Vafaeimanesh J, Mirzamohammadi F, Falaknazi K. Association of Helicobacter pylori infection and serum albumin in patients on hemodialysis. Iran J Kidney Dis. 2010 Oct;4(4):312-6.

Satoh H, Saijo Y, Yoshioka E, Tsutsui H. Helicobacter pylori infection is a significant risk for modified lipid profile in Japanese male subjects. J Atheroscler Thromb. 2010 Oct;17(10):1041-8.

Aarabi MH, Alvani S, Ehteram H. Lipid Profile in Subjects with Helicobacter pylori infection. Iranian J Pathol. 2010;5(4):199-203.

Huang B, Chen Y, Xie Q, Lin G, Wu Y, Feng Y, et al. CagA-positive Helicobacter pylori strains enhanced coronary atherosclerosis by increasing serum oxLDL and hsCRP in patients with coronary heart disease. Dig Dis Sci. 2011 Jan;56(1):109-14.

Hack-Lyoung Kim, Han Ho Jeon, In Young Park, Jin Man Choi, Ji Sun Kang, Kyueng-Whan Min. Helicobacter pylori infection is associated with elevated low density lipoprotein cholesterol levels in elderly Koreans. J Korean Med Sci. 2011;26:654-8.

Murray LJ, Bamford KB, O'Reilly DP, McCrum EE, Evans AE. Helicobacter pylori infection: relation with cardiovascular risk factors, ischaemic heart disease, and social class. Br Heart J. 1995 Nov;74(5):497-501.

Regnström J, Jovinge S, Båvenholm P, Ericssond C-G, De Faire U, Hamsten A, et al. Helicobacter pylori seropositivity is not associated with inflammatory parameters, lipid concentrations and coronary artery disease. J Intern Med. 1998 Feb;243:109-13.

Pilotto A, Rumor F, Franceschi M, Leandro G, Novello R, Soffiati G, et al. Lack of association between Helicobacter pylori infection and extracardiac atherosclerosis in dyspeptic elderly subjects. Age Ageing. 1999 Jul;28(4):367-71.

Kowalski M. Helicobacter pylori (H. pylori) infection in coronary artery disease: influence of H. pylori eradication on coronary artery lumen after percutaneous transluminal coronary angioplasty: the detection of H. pylori specific DNA in human coronary atherosclerotic plaque. J Physiol Pharmacol. 2001 Aug;52(1 Suppl 1):3-31.

Elizalde JI, Piqué JM, Moreno V, Morillas JD, Elizalde I, Bujanda L, et al. Influence of Helicobacter pylori infection and eradication on blood lipids and fibrinogen. Aliment Pharmacol Ther. 2002 Mar;16(3):577-86.

Ongey M, Brenner H, Thefeld W, Rothenbacher D. Helicobacter pylori and hepatitis A virus infections and the cardiovascular risk profile in patients with diabetes mellitus: results of a population-based study. Eur J Cardiovasc Prev Rehabil. 2004 Dec;11(6):471-6.

Volanen I, Raitakari OT, Vainionpää R, Arffman M, Aarnisalo J, Anglé S, et al. Serum lipid profiles poorly correlate with Chlamydia pneumoniae, Helicobacter pylori, and cytomegalovirus seropositivity in prospectively followed-up healthy children. Arterioscler Thromb Vasc Biol. 2005 Apr;25(4):827-32.

Zhang L, Gail MH, Wang YQ, Brown LM, Pan KF, Ma JL, et al. A randomized factorial study of the effects of long-term garlic and micronutrient supplementation and of 2-wk antibiotic treatment for Helicobacter pylori infection on serum cholesterol and lipoproteins. Am J Clin Nutr. 2006 Oct;84(4):912-9.

Allain CC, Poon LS, Chan CSG, Richmond W, Fu PC. Enzymatic determination of total serum cholesterol. Clin Chem. 1974;20:470-5.

Roeschlau P, Bernt E, Gruber WA. Enzymatic analysis of total cholesterol. Clin Chem Clin Biochem. 1974;12:226-8.

Burstein M, Scholinick HR, Marfin R. Rapid method for the isolation of lipoproteins from human serum by precipitation with polyanions. J Lipid Res. 1970;11:583-95.

Fossati P, Prencipe L. Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide. Clin Chem. 1982;28:2077-80.

Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972;18:499-502.

Arvind AS, Cook RS, Tabaqchali S, Farthing MJG. One minute endoscopy room test for Campylobacter pylori. Lancet. 1988;i:704.

Thillainayagam AV, Arvind AS, Cook RS, Harrison IG, Tabaqchali S, Farthing MJG. Diagnostic efficiency of an ultrarapid endoscopy room test for Helicobacter pylori. Gut. 1991;32:467-9.

Woods A, Brull DJ, Humphries SE, Montgomery HE. Genetics of inflammation and risk of coronary artery disease: the central role of interleukin-6. Eur Heart J. 2000;21:1574-83.

Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002 Nov;347(20):1557-65.