Should H. pylori screening be integrated into MI care protocols?

<i>Helicobacter pylori</i> is considered a modifiable and exacerbating risk factor in influencing post-myocardial infarction (MI) upper gastrointestinal (GI) bleeding, either due to antithrombotic therapies or other mechanisms. Numerous studies suggest high prevalence of <i>H. pylori</i> in post-MI patients, emphasizing the role of screening of <i>H. pylori</i> and timely introduction of eradication therapy in infected individual as a cost-effective strategy. <i>H. pylori</i> is not only involved in post-MI bleeding but also play a role in triggering myocardial events and its recurrences through plaque destabilization, inflammatory response while its role in dyslipidemia remains inconsistent. This issue is under investigation since 2000 and had shown a significant relationship between involvement of <i>H. pylori</i> (especially CagA strains) and MI, role of genetics and environmental factors in triggering <i>H. pylori</i> in MI patients; however, most evidence up to date are either observational or cohort studies. Current randomized controlled trials (RCTs) suggest the role of targeted screening in high-risk population and area proved to be beneficial than blanket screening. However, lack of subgroup analysis with RCTs and long-term follow-up is necessary to establish the role <i>H. pylori</i> screening in preventing recurrent MI, reducing upper GI bleeding and cardiovascular outcomes. Furthermore, integrating inflammatory biomarkers and genetic factors in screening might help in risk stratification.