H. pylori eradication reduces cholesterol and LDL in patients with cardiovascular disease risk

BACKGROUND AND AIMS: Cardiovascular disease (CVD) remains the leading cause of mortality worldwide. Beyond traditional risk factors, chronic inflammation is increasingly recognized in its pathogenesis. Helicobacter pylori (H. pylori) infection has been proposed as a potential contributor. This study aimed to investigate the long-term effects of successful H. pylori eradication on selected CVD risk factors. METHODS: Seventy-two patients were enrolled between July 2020 and November 2022 and randomized to two 14-day regimens (group 1: esomeprazole, amoxicillin, clarithromycin; group 2: esomeprazole, amoxicillin, metronidazole, colloidal bismuth subcitrate). Outcomes included homeostatic model assessment of insulin resistance (HOMA-IR) index, lipid profiles and subfractions, and urinary trimethylamine N-oxide (TMAO), assessed by nuclear magnetic resonance spectroscopy. Assessments were performed at baseline, two months, and one year after confirmed H. pylori eradication. RESULTS: Of the 72 enrolled patients, 13.9% (10/72) were lost to follow-up. Baseline CVD risk factors did not differ significantly between groups. After successful eradication, both groups demonstrated significant reductions in total cholesterol (p=0.003), low-density lipoprotein cholesterol (p=0.010), small dense lipoprotein particles (p=0.037), and marginal decrease in TMAO concentrations (p=0.048). No significant changes were observed in body mass index (p=0.799), waist circumference (p=0.305), or HOMA-IR index (p=0.275). CONCLUSIONS: Successful eradication of H. pylori infection was associated with favorable changes in lipid metabolism and marginal decrease in TMAO levels. These findings suggest that H. pylori may contribute to CVD risk by modulating lipoprotein profiles and systemic inflammation.