Helicobacter pylori Infection Is Associated With Carotid Intima and Media Thickening: A Systematic Review and Meta-Analysis

Background Helicobacter pylori (H. pylori) infection affects approximate to 4.4 billion people worldwide. Several studies suggest that this pathogen impacts the digestive system, causing diverse and severe conditions, and results in extragastrointestinal disorders like vascular diseases. Our study aims to examine the association between H. pylori infection and carotid intima-media thickness. Methods and Results Electronic databases (MEDLINE, Embase, CENTRAL, Web of Science, and Scopus) were searched for studies, comparing the thickness of the carotid intima-media in H. pylori-infected and noninfected individuals listed until October 20, 2020. Statistical analyses were performed using the random effects meta-analysis of model of weighted mean differences with the corresponding 95% CI using the DerSimonian and Laird method. The protocol was registered in advance in PROSPERO (International Prospective Register of Systematic Reviews; CRD42021224485). Thirteen studies were found meeting inclusion criteria for our systematic review and meta-analysis, presenting data on the thickness of the carotid intima-media considering the presence of H. pylori infection. Altogether, 2298 individuals' data were included (1360 H. pylori positive, 938 negative). The overall carotid intima-media thickness was significantly larger among infected patients compared with uninfected participants (weighted mean difference: 0.07 mm; 95% CI, 0.02-0.12; P=0.004; I-2=91.1%; P<0.001). In case of the right common carotid artery, the intima-media thickening was found to be significant as well (weighted mean difference, 0.08 mm; 95% CI, 0.02-0.13, P=0.007; I-2=85.1%; P<0.001), while it showed no significance in the left common carotid artery (weighted mean difference, 0.12 mm; 95% CI, -0.05 to 0.28, P=0.176; I-2=97.4%; P<0.001). Conclusions H. pylori infection is associated with increased carotid intima-media thickness. Therefore, the infection may indirectly contribute to the development of major vascular events.