Association Between Small Intestinal Bacterial Overgrowth by Glucose Breath Test and Coronary Artery Disease
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A possible role of gut bacteria and their metabolic by-products in the development of coronary artery disease (CAD) is suspected. There is a lack of studies evaluating the association of small intestinal bacterial overgrowth (SIBO) with the development of CAD.
To evaluate the frequency and risk factors for angiography-confirmed CAD in patients with or without SIBO.
A total of 1059 patients tested for SIBO using the glucose hydrogen/methane breath test from 2006 to 2014 were evaluated. In total, 160 had coronary artery angiography and were included in the study. SIBO-positive patients were compared to SIBO-negative patients. Demographic, clinical, and laboratory variables and the presence of CAD on coronary angiography were analyzed.
Patients with SIBO had a higher frequency of CAD (78.9 vs. 38.6%, p < 0.001), diabetes mellitus (40.0 vs. 22.9%, p = 0.016), chronic kidney disease (26.7 vs. 12.9%, p = 0.025), use of angiotensin conversion enzyme inhibitor/blocker (45.5 vs. 32.9%, p = 0.008), and statins (75.6 vs. 61.4%, p = 0.004). Patients with SIBO had an increased number of coronary arteries affected compared to SIBO-negative patients (1-vessel disease 67.2 vs. 32.8%, p < 0.001; 2-vessel disease 85.7 vs. 14.3%, p < 0.001; and 3-vessel disease 82.4 vs. 17.6%, p < 0.001, respectively). In the stepwise multivariate logistic regression analysis, SIBO remained an independent risk factor for CAD (odds ratio 7.18, 95% confidence interval 3.09–16.67; p < 0.001).
SIBO was found to be associated with CAD and with the number of coronary arteries involved in this study from a single tertiary center. Further studies are necessary to confirm the association of SIBO with CAD. In the presence of risk factors, patients with SIBO may benefit from assessment for CAD.
KeywordsSmall intestinal bacterial overgrowth Coronary artery disease Metabolic disease
Body mass index
Coronary artery disease
Chronic kidney disease
Gastroesophageal reflux disease
Proton pump inhibitor
Small intestinal bacterial overgrowth
Dr. Bo Shen is supported by the Ed and Joey Story Endowed Chair.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to disclose.
- 9.National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–3421.Google Scholar
- 10.Dosh K, Berger PB, Marso S, et al. Relationship between baseline inflammatory markers, antiplatelet therapy, and adverse cardiac events after percutaneous coronary intervention: an analysis from the clopidogrel for the reduction of events during observation trial. Circ Cardiovasc Interv. 2009;2:503–512.CrossRefPubMedGoogle Scholar
- 12.Valgimigli M, Ceconi C, Malagutti P, et al. Tumor necrosis factor-alpha receptor 1 is a major predictor of mortality and new-onset heart failure in patients with acute myocardial infarction: the Cytokine-Activation and Long-Term Prognosis in Myocardial Infarction (C-ALPHA) study. Circulation. 2005;111:863–870.CrossRefPubMedGoogle Scholar
- 13.Kowalski M. Helicobacter pylori (H. pylori) infection in coronary artery disease: influence of H. pylori eradication on coronary artery lumen after percutaneous transluminal coronary angioplasty. The detection of H. pylori specific DNA in human coronary atherosclerotic plaque. J Physiol Pharmacol. 2001;52:3–31.PubMedGoogle Scholar
- 14.Bullon P, Cordero MD, Quiles JL, Morillo JM, del Carmen Ramirez-Tortosa M, Battino M. Mitochondrial dysfunction promoted by Porphyromonas gingivalis lipopolysaccharide as a possible link between cardiovascular disease and periodontitis. Free Radic Biol Med. 2011;50:1336–1343.CrossRefPubMedGoogle Scholar
- 40.Chu H, Fox M, Zheng X, et al. Small intestinal bacterial overgrowth in patients with irritable bowel syndrome: clinical characteristics, psychological factors, and peripheral cytokines. Gastroenterol Res Pract. 2016;2016:3230859. https://doi.org/10.1155/2016/3230859.PubMedPubMedCentralGoogle Scholar