Helicobacter pylori eradication and the prevention of peptic ulcer bleeding and cardiovascular disease progression in chronic aspirin users

BACKGROUND Long-term low-dose aspirin (LDA) use is associated with an increased risk of peptic ulcer bleeding (PUB). Helicobacter pylori (H. pylori ) infection is a well-known risk factor for peptic ulcer disease (PUD). AIM To evaluate the prevalence of H. pylori infection in long-term LDA users, assess the impact of eradication on PUB risk, and explore its association with cardiovascular (CV) disease status and progression. METHODS A prospective observational study was conducted at Benha Teaching Hospital from January 2023 to January 2024. Four hundred adults (≥ 18 years) on daily LDA for at least one year were enrolled. All participants underwent a comprehensive evaluation, including assessment of CV comorbidities. H. pylori was diagnosed via a stool antigen test, urea breath test, and histopathology. Infected patients received levofloxacin-based triple therapy for 14 days. Eradication was assessed at six weeks, and participants were followed for six months to evaluate PUB incidence and CV outcomes, including disease progression. RESULTS The prevalence of H. pylori infection was 65.5% (262/400). H. pylori -positive patients exhibited significantly lower albumin levels (3.5 ± 0.4 g/dL vs 3.9 ± 0.6 g/dL, P < 0.001) and higher levels of urea (29.3 ± 6.4 mg/dL vs 23.5 ± 4.6 mg/dL, P < 0.001), sodium (137.8 ± 2.9 mmol/L vs 135.3 ± 3.5 mmol/L, P < 0.001), potassium (4.1 ± 0.9 mmol/L vs 3.8 ± 0.6 mmol/L, P = 0.014), and cholesterol (191.0 ± 29.7 mg/dL vs 177.0 ± 35.9 mg/dL, P = 0.004). PUB was significantly more prevalent in H. pylori -positive patients with gastric erosions (12.2% vs 0.0%, P < 0.001), peptic ulcers (23.7% vs 0.0%, P < 0.001), and gastric ulcers (10.7% vs 0.0%, P < 0.001). After eradication therapy, 51.9% (136/262) of patients tested negative for H. pylori , while 48.1% (126/262) remained positive. PUB was significantly more frequent in patients with persistent H. pylori infection (8.7% at 6 weeks, 11.9% at 6 months) compared to those with successful eradication (1.5% at 6 weeks, 3.7% at 6 months, P < 0.001), highlighting the importance of successful eradication in reducing PUB risk. Additionally, H. pylori -positive patients had a higher prevalence of ischemic heart disease (54.3% vs 33.3%, P < 0.001) and a higher burden of CV disease progression during follow-up (hazard ratio = 3.5, P < 0.001), suggesting a potential interaction between H. pylori infection and CV risk. CONCLUSION Successful screening and eradicating H. pylori in high-risk LDA users was associated with significantly reduced PUB risk and was linked to less CV disease progression in patients with persistent infection.