Meta-Analysis Reveals 54 Percent Increased Risk of AAA in Patients With H. pylori Infection
India: A new meta-analysis published in BMC Cardiovascular Disorders has highlighted a potential connection between Helicobacter pylori (H. pylori) infection and the development of abdominal aortic aneurysm (AAA). The findings suggest that H. pylori may significantly elevate the risk of AAA, pointing to an underexplored target for preventive strategies in vulnerable adults.
The study was conducted by Dr. Phanish Chandra Ravi, S.V.S. Medical College, Mahabubnagar, India, and colleagues.
AAA is a potentially life-threatening condition, particularly in older adults, as it often progresses silently until rupture. Identifying modifiable or preventable factors is therefore a critical priority in reducing disease burden. According to the authors, chronic H. pylori infection—well-known for its role in peptic ulcers and gastric cancer—may extend its influence beyond the gastrointestinal tract, contributing to systemic vascular inflammation that drives aneurysm development.
The study synthesized evidence from eight observational studies to evaluate whether H. pylori infection contributes to AAA risk. It led to the following findings:
The study revealed the following findings:
- Individuals with Helicobacter pylori infection had a 54% higher likelihood of developing abdominal aortic aneurysm (AAA), with a pooled risk ratio of 1.54.
- The overall event rate of AAA among H. pylori-positive individuals was 41%, with notable variability across different populations and study designs.
- Subgroup and sensitivity analyses confirmed that the association between H. pylori and AAA persisted despite differences in geography, methodology, and patient characteristics.
- Findings suggest that chronic infection may contribute to vascular alterations that increase susceptibility to aneurysm formation.
However, the study also acknowledged important limitations. Since the analysis was based on observational studies, the risk of confounding remains high. Differences in diagnostic approaches for H. pylori infection, inconsistent definitions of AAA, and variability in population demographics made data pooling challenging. Moreover, unmeasured factors such as dietary patterns, socioeconomic status, and coexisting inflammatory conditions may have influenced the reported associations. The authors also noted the possibility of publication bias, as studies showing no association could have been underrepresented.
Despite these caveats, the findings raise compelling questions about the role of chronic infection in cardiovascular disease. The authors emphasize the need for large-scale prospective cohort studies using standardized diagnostic tools and rigorous adjustment for confounders to strengthen the evidence base. In addition, mechanistic studies investigating how H. pylori, particularly virulent CagA-positive strains, may trigger vascular inflammation and structural weakening of the aortic wall could help establish causality.
If validated, the association between H. pylori and AAA could have significant clinical implications. Routine screening for H. pylori in older adults, alongside established cardiovascular risk assessments, might become an additional strategy to reduce aneurysm risk. Furthermore, eradication of the infection through antibiotic therapy could potentially serve as a preventive intervention in high-risk groups, though this approach requires further study.
"The meta-analysis emphasizes a noteworthy link between H. pylori infection and abdominal aortic aneurysm, providing fresh insights into vascular risk factors beyond traditional contributors. While the evidence calls for cautious interpretation, it highlights an avenue for future research aimed at prevention, early detection, and improved outcomes in AAA patients," the authors concluded.
Reference:
Arain, M., Karnatapu, J., Moradi, I. et al. Association between helicobacter pylori infection and abdominal aortic aneurysm: a systematic review and meta-analysis. BMC Cardiovasc Disord 25, 676 (2025). https://doi.org/10.1186/s12872-025-05148-y
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