Letter to the Editor Helicobacter pylori and atherosclerosis: Can current data be useful for clinical practice? B. Longo-Mbenza Department of Internal Medicine and Division of Cardiology, Clinical Epidemiology and Pathophysiology, University of Kinshasa, Democratic Republic of the Congo Received 2 January 2008; accepted 24 April 2008 Available online 22 July 2008 Keywords: Helicobacter pylori; Coronary heart disease; Eradication We very much appreciate to read the letter to the Editor from Drs Pellicano R and Fagoonee S [1] with relevant comments to our recent article [2]. They critically remarked the usefulness and the generalized message encouraging Helicobacter pylori eradication to pre- vent coronary artery disease (CAD) or its recurrence. Indeed, the lack of association between H. pylori infection and athe- rosclerotic cardiovascular diseases has also been observed by some papers with conflicting results [3]. However, the data o, significant association between infection in general (H. pylori in particular) and CAD with evidence level III are more fre- quent than conflicting results. Despite the limitations of our hospital-based data concern- ing “Prevention of the metabolic syndrome insulin resistance and the atherosclerotic diseases in Africans infected by Heli- cobacter pylori infection and treated by antibiotics” [2], of great interest are the case-control and the longitudinal ap- proach of the methods procedure within a homogenous Bantu ethnic group. There were both chronic and acute (stroke, angor pectoris myocardial infarction) atherosclerotic diseases with- in a specific environment. Atherosclerosis was anecdotally reported in Africa during 1900s, but emerging now with epidemic rates [4]. Established coronary heart disease risk factors account for only about one third of acute events [5] and do not fully explain the temporal and geographical variations in CAD worldwide. Each region of sub-Saharan Africa has its peculiar expressing of epidemiological and clinical features of atherosclerosis [5]. This has fostered the search for causal association between different components of the metabo- lic syndrome, atherosclerotic cardiovascular diseases and H. pylori infection having in mind all the 8 criteria of Sir Hill in general [6] and intervention-induced reversibility in particular. Therefore, we stated that “H. pylori infection might be one of the risk factors of atherosclerosis through inflammation and modulation of glucose, pulse pressure, and lipid by low cost antibiotics in our developing country” [2]. We never wanted to state that above mentioned risk factors can be corrected by antibiotic treatment. However, a significant reduction in the levels of different CAD risk factors after the cure of the bacterium was shown by our paper as reported elsewhere [7]. Excluding patients with angor pectoris, myocardial in- farction, stroke, cigarette smoking habit, diabetes mellitus, chronic CAD, and peripheral vascular disease, we recently demonstrated a causal relationship between H. pylori sero- positivity, H. pylori chronic or active histologically gastritis, and cardiovascular risk (pre-atherosclerotic stiffness, arterial hypertension) among Congolese patients with dyspepsia [8]. Our ongoing and convincing data on the effect of systematic H. pylori eradication in a long term on the reduction of severely high blood pressure or blood glucose in patients with H. pylori chronic gastritis and uncontrolled hypertension and diabetes mellitus (unpublished data). In conclusion, we agree the comments of Drs Pellicano R and Fagoonee S on the Pathophysiology of atherosclerosis as an inflammatory disease with interactions between immune mechanisms and metabolic risk factors initiated by endothe- lial dysfunction, and conflicting data on H. pylori eradica- tion-induced reduction of cardiovascular risk factors. Our message encouraging H. pylori eradication to prevent CAD risk factors. Other longitudinal studies without important biases in rich countries are needed before a generalized message for H. pylori eradication to prevent CAD. International Journal of Cardiology 135 (2009) e76 – e77 www.elsevier.com/locate/ijcard E-mail address: longombenza@yahoo.fr . 0167-5273/$ - see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2008.04.039