Helicobacter pylori is an independent risk factor for carotid plaque formation as well as higher BMI and triglyceride levels, according to findings from a cross-sectional study published in Annals of Medicine. The findings may have clinical implications for H pylori screening and treatment, the study researchers noted.

The researchers analyzed data from 810 patients treated at Dezhou People’s Hospital in China from January 2016 to December 2019. None of the patients had a history of hyperlipidemia and/or chronic disorders, such as coronary heart disease, stroke, hypertension, and diabetes.

All of the patients underwent a 2-step fasting 13C-urea breath test (13-UBT) for detection of Helicobacter pylori. Cervical blood vessels were imaged using Doppler ultrasound. Data on sex, age, weight, height, BMI, blood pressure, medical history were collected, and levels of triglyceride, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were measured. Approximately half of the patients were aged 44 to 55 years, 40% were younger than 44 years, and 13% were older than 55 years. 

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Approximately 46% of patients were H pylori positive and 44% were H pylori negative. Cervical vascular plaque formation was found in 291 patients in the overall group (40%) and was found at a significantly higher rate in the H pylori-positive group than in the H pylori-negative group (41% vs 29%, respectively; Table).

Patients who tested positive for H pylori infection also were significantly more likely to have a BMI ≥25 and triglycerides >1.7 mM (Table). Levels of total cholesterol, HDL, and LDL were not significantly different among patients with or without H pylori infection.

Table. Factors Associated With H pylori Infection

FactorH pylori NegativeH pylori PositiveP value
Cervical vascular plaque29%41%<0.001
BMI ≥2538%50%0.001

Additionally, H pylori infection was a significant independent risk factor for plaque formation, elevated BMI, and higher triglyceride levels in a multivariate logistic regression analysis (odds ratio, 1.46, 1.43, and 1.42, respectively).

Possible explanations for this relationship are that “H pylori can directly invade blood vessels to mature monocytes, accelerate the proliferation of vascular smooth muscle cells or endothelial cells, and promote thrombosis,” the study authors noted. The increased triglyceride levels and BMI in patients with H pylori infection may be confounding factors in the link between H pylori and carotid atherosclerosis risk, they said.  

Another proposed mechanism is that H pylori infection can cause chronic gastritis, peptic ulcers, and other gastrointestinal diseases that may affect the absorption and utilization of vitamins, in turn causing homocysteine levels to accumulate in the body, according to the researchers. Previous research suggests that increased homocysteine levels may be linked to atherosclerosis and thromboembolic diseases.


Liang H, Lin S, Ji Y, Xiao Y, Zheng G. Helicobacter pylori increases the risk of carotid plaque formation: a clinical evidence. Ann Med. 2021;53(1): 1448-1454. doi:10.1080/07853890.2021.1927169.