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Papers without major electrocardiographic abnormalities at baseline (47% v 35%; difference 12.7% 5.1% to 20.7%). Comment On cross sectional analysis we found no association between Hpflor/seropositivity and cardiovascular dis- eases (assessed in several ways) in our 624 elderly sub- ject~ Because H pflori seroposidvity did not predict total or cardiovascular mortality during a five year fol- low up, our results offer no evidence for an association between Hpy/ar/infection and coronary heart disease, and they differ from those reported recendy in younger subjects.~ Our results do not exclude the possibility that chronic Hpy/od infection acquired early in life may increase the lifelong risk of coronary heart disease. By analogy with serum cholesterol concentra- don in elderly m~bject& controlled intervention studies may be needed to a~certain whether eradicating Hpylori infection in certain subgroups is worthwhile. Funding: Ragnar Ekbetg Fotm.dation and YrjO Jahnsson Foundation, Helsinki, Huland. Conflict of im~ None Patel R Mendall MA. Carrington D, Smtchan D, Leatham E, Molineaux N, a a/. Atu~:iation of Helicobacter pylori and Chhmydia pneumoniae infections with coronary heart disease and cardiovavxdar risk factm-t BMJ 1995",31 h711-4. 2 Murray LJ, Bamford KB, O'Reilly DPJ, McCrum EE, Evam AE. Helkobacter pylori infection: reladon with cardiovasodar risk factort, hdaaemic heart dttea~, and uxdal ciatt Br Heart.[ 1995;74:497-501. S Kommen TU, HOOk J, Rantetin HI, Myllyla G. Age-dependent increate of Campylobacter pylori anu]3odiet in blood donor~ S~andf 1989;24:110.4. 4 Lindroo$ M, Kupari M, HeikkiRt J, T'dvis RS. Pre~ence of aor6c valve abnormalities in the elde~: an eehocardiographic study of a random population sample.JAm Co//~ 1993;21:1220-5. (acrtpud 15 Nomnk, r Z 996) Helicobacter pylon infection and coagulation in healthy people Fabrizio Parente, Giow2nni Maconi, Venerina Imbesi, Omella Sangaletti, Marina Poggio, Edoardo Rossi, Piergiorgio Duca, Gabriele Bianchi Porto 0 o~ L0 4~ o Department of Gastroenterology, L S~ U~i~ Hospi~ Wm G B G~ 74, 20157 M~ t~ F~o ~t~ Gio~ M~ V~ ~ G~fide B~ Po~ ~of~ ~tol~, L S~ U~ Ho~i~ ~ D~t ~ M~ S~ ~d Biome~, U~v~i~ of ~ Co~nd~ce ~f~r BMJ 1997'314:1318-9 Helicobaaer pylori infection has recendy been associ- ated with an increased risk of developing ischaemic heart disease.' * It has been suggested that chronic gas- tritis related to Hpylori infection may increase, through inflammatory mediators, the concentration of certain coagulation factors such as fibrinogen,~ which are pre- dictors of ischaemic heart disease2 We investigated the potential assodadon between H py/or/infection and abnormalities of plasma coagulation in healthy people, with particular emphasis on the poss~ility of H py/or/ inducing a tendency tox~rards coagniadon, thereby influencing the risk of ischaemic heart disease. Subjects, methods, and results Initially, 368 comecutive asymptomatic blood donors (unpaid volunteers) were recruited for this study. Exclusion criteria were age > 51 years, any chronic drug treatment, recent intake of drugs interfering with blood coagulation, use of oral contraceptives, previous treatment for H pflor/infection, pregnancy or breast feeding, and previous diagnosis of ischaemic heart dis- ease, peptic ulcer, or any systemic chronic illnes,s. Dietary habits, alcohol and cigarette consumption, and sodoeconomic status were determined. A total of 300 subjects (229 men) aged 20-51 (mean 34.7) years fulfilled the inclusion criteria and were enrolled into the study. A resting venous blood sample was taken in all subjects and was analysed for concentratiom of total cholesierol, C reactive protein, plasma tibrinogen, factor VII C, arid haemoglobin; erythrocyte sedimenta- tion rate; prothrombin time; partial thromboplastin time; and platelet and leucocyte count. Prothrombin cleavage fragment (factors I and ID, an index of prothrombin activation,~ was also assayed. IgG anffbodies specific to H py/or/ were determined by using a commercial ELISA kit (Helori test, Eurospital, Trieste, Italy); a cut off value of 19% was used, based on previous analysis of 200 patients (semidvity compared with histology, 92%; spedfidty, 94%0). Student's t test and the X~ test were used to compare characteristics of subjects and values of haemostadc factors in subjects with and without Hpy/or/irYection; multiple regression was used to assess the effects ofcovariates. The overall prevalence of H py/or/infection was 53% (158/300). Table 1 shows that subjects positive for Hpy/or/were significantly older than those negative for Hpy/or~ The groups did not differ significandy in other characteristics or in values for plasma fibrinogen, cholesterol, leucocyte and platelet count, erythrocyte sedimentation rate, prothrombin time, partial throm- boplast£n time, and C reactive protein. However, concentrations of factor VII C and prothrombin cleav- age fragment were significandy higher in positive than in negative subjects, though the association disap- peared after adjustment by muldple logisdc regression for age, sex, and sodal dass~ Comment As plasma fibrinogen and total leucocyte count, which are well known risk factors for ischaemic heart disease, ~ are increased in patients infected with H py/or/,' the increased risk of ischaemic~heart disease in people posidve for H py/or/may be mediated through raised plasma fibrinogen concentrations. However, a large cross sectional population survey failed to find a significant association between H py/or/ and fibrinogen.~ These studies may be biased because the)" included patients with ischaemic heart disease, a condition which could be associated with increased concentrations of coagulation factors irrespective of patients' Hpy/or/status. Comparing the concentladons of circulating coagulation factors in healthy people 1318 I~MJ VOLL,%tESl4 3 MAY I997

Papers Table 1 Mean (SD) age and circulating coagulation factors in healthy people with and without Helicobacter pylori infection, and multiple regression analysis using concentrations of factor VII C and prothrombin cleavage fragment {factors I and II) as dependent variables and H pylori status, smoking habits (0=no; 1=yes), sex (0=female; 1=male), and age (in years) as independent variables (ita14~) (ea151) Olfleflllce or ¢on'M|tion co|fficleM (96% CI) Vedeld~ Age (yeas) 32.2 (7.4) 37.0 (7.9) -4.8 (-6.54 to -3.06) Ptatalet count (xl0S/1) 216.7 (42.9) 210.2 (50.9) 6.5 (-4.26 to 17.26) Lelcoc'/ta count (x 108/1) 6.41 (1.6) 8.41 (1.8) 0 (-0.39 to 0.39) Eq/t~ sedimentation rata 5.81 (4.2) 5.57 (5.2) 0.24 (-0.84 to 1.32| C rzact~ protein (mg/1) 8.0 (6.0) 9.1 (7.0) -1.1 (-2.5 to 0.5) Pto~rombin time (ratio) 0.93 (0.1) 0.93 (0.2) 0 (-0.04 to 0`04) P'art~ thromboplastin time (ratio) 1.53 (0.2) 1.00 (0.2) 0`03 (-0.02 to 0`08) Factor Vll:C (%) 84.6 (18,4) 89.3 (17.7) -4.7 (-6.80 to -0.60) Rbrino~n (g/1) 3.36 (8.5) 3.42 (8.7) -0`06 (-2.20 to 1.90) Factors 1 + 2 (nmoVl) 0.89 (0.3) 1.00 (0`4) -0.11 (-0.19 to -0.03) Multiple ~egression Prct~rombin cleavage fragment (/:1~0.54): H pylon' status 0.002 (-0.05 to 0.59) Smoking 0.075 (0.020 to 0.130) Sex 0.080 (-0.145 to -0.015) Age 0.018 (0.014 to 0.022) (Co~'tont) 0.318 (0.196 to 0.440) Factor VII C (Re0.40): H py/od status 1.209 (-2.768 to 5.188) Smoking 8.017 (4.138 to 11.896) Sea 4.748 (-9.332 to -0.104) Age 0.710 (0.458 to 0`9ei) (Constant) 61.955 (53.390 to 70.520) with and without H py/or/infection, we found that/-/ py/or/ infection is not associated with increased circulating concentmtious of fibrinogen, factor VII:C, or prothrombin cleavage fragment, or with other hae- mostatic factors, which does not support the possibility of this infection inducing a tendency towards a proco- agulant state. Thus it seems unlikely that Hpy/or/infec- tion predisposes the development of ischaemic heart disease through effects on the coagulation system. Funding: VI is partly funded by a grant from Takeda Farma- ceudci Italia. Conflict of interest: Non~ Mendall MA, Goggin PM, Molineaux N, LevyJ, Toosy T, Strachan D, a aL Relation of Helicotmcm- wlori infecfon and coronary heart disease. Br Hmrq 1994;71:4~7-9. Murray LJ, Bamford KI~ O'Rcflly DP, McCrum EE, E~r~ AE. Heiicobacm" pylori infection: retaken with cantiova.scul~ risk factors, itchaemic heart dfneas~ and sodal ~ Br HmrtJ 1995;74:49%50L Pa~ P, MendaIl MA, Carringy.on D, Strachan DP, Leatham E, Mo]ineaux N, ~ a/. ~n of He~cobacter pylod and Chlamydia pr~umoniae infecdom with coronary heart disease and cardiovasogar risk factors. ~ 1995;311:711-4. PJ, a a~ F~rinogen, viscosity, and white blood cell count am major risk favors for isc.haemic hear t disease. C/rcu/at/on 199 I'~3.'8~>44. Mannucd PM, Tripodi A, Bottasso B, Baudo F,F'ma2zi G, De Stefano V, e* a/. Marke~ of procoagulant imbahace in patient~ wlth inherited throm. bo~c syndrom~ T'an~nbos/s and Ha,-ta0sta~/s 1992,'67:200-2. (~ 29 No~J~r Z 996) A memorable book From magic to science I graduated in Prague, Czechoslovakia, in 1939 one month before the Czech capital was occupied by the Nazis. I was lucky to escape to Palestine, where I joined the Czechoslovak Axmy, later to be transferred to the Royal Army Medical Corps. In order to acquaint myself with the British pharmacopoeia--somewhat different from the cenwal European one--I looked up in the hospital's small l~rary a textbook of clinical pharmacology. Itwas in fact American--by Harry Beckmann- Here I must point out that not only pharmacology but the whole concept of medicine at that time was different on the continent than in the Angio-Saxon world During our studies we were inculcated with the deepest admiration for our elders, whose views were not to be disputed. Traditions were sacred; the doctor's social status was maintained by a pompous gravi~. Sceptical questioning was frowned on, and even a trace of humour was sacrileg~ Now I opened a book written in a highly readable, enterta/ning style often spiced with humour. Drugs were evaluated with caution. I still remember the following story. For many years acute cholecystitis used to be treated by a drug, I forget its name as k has been long forgotten by alL A few researchers in the United States examined the bile from postoperative blliary fistulas after having administered the drug. Not a trace of it or its metabolites was found on analys~. A tenet of decades was destroyed in a matter of weeks. The iconoclastic questioning, the constant search for proof of every hypothesis, has been the hallmark of medicine in the Anglo-Saxon world. That is what I discovered in the booL Even after 50 years living in England I are still filled with gratitude and joy at having found out what turned medicine from magic to science. Of course there are still small pockets of the old "sacred cow" attitude here as much as ehewhere, but in general the critical spirit of evidence guided medicine has taken firm root on the continent It is up to politicians and economists to detibemte whether Britain needs Europe. In medicine, however, Europe certainly needs Britain. Jan Pollen is a retired chest physician in lwndon 0 0 BM]" VOLUMESI4 SMAY 1997 1319