Relationship Between Helicobacter pylori, Trimethylamine-N-Oxide, and Carotid Plaque Formation Among Adult Health Checkup Population in China.

BACKGROUND

Both trimethylamine-N-oxide (TMAO) and Helicobacter pylori (H. pylori) have been linked to atherosclerosis and carotid plaque development. This study examined the associations of H. pylori infection and plasma TMAO levels with carotid plaque in a health screening population.

METHODS

Between October 2022 and September 2023, 1779 participants undergoing routine health examinations, including carotid ultrasonography and H. pylori testing, were enrolled. Multivariable logistic regression was used to evaluate the association between H. pylori infection and carotid plaque. Inverse probability weighting (IPW) was applied to address selection bias in the TMAO subgroup, followed by weighted logistic regression analyses.

RESULTS

Carotid plaque was more prevalent among H. pylori-seropositive participants than among seronegative participants (53.96% vs. 40.37%, p < 0.001). In multivariable logistic regression analyses, H. pylori seropositivity remained significantly associated with carotid plaque after adjustment for demographic characteristics and cardiovascular risk factors, with odds ratios ranging from 3.099 to 3.392 across the adjusted models (all p < 0.001). Higher TMAO levels were associated with carotid plaque in unadjusted analyses and remained associated after adjustment for demographic and conventional cardiovascular risk factors; however, these associations were attenuated and became statistically non-significant after further adjustment for age. No significant association was observed between H. pylori seropositivity and plasma TMAO levels.

CONCLUSIONS

H. pylori infection was associated with carotid plaque in this cross-sectional study. The association between TMAO and carotid plaque appeared to be largely explained by age. Given the cross-sectional design, causal relationships cannot be inferred, and further prospective studies are warranted.