Helicobacter pylori Infection Is Associated with Elevated Insulin Resistance and Cardiovascular Risk, Particularly in Otherwise Low-Risk Individuals: The Tongren Health Care Study

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However, the relationship between H. pylori infection and cardiovascular diseases (CVD) remains controversial. This study aims to investigate the association between H. pylori infection and 10-year cardiovascular risk. Methods: A total of 1,398 subjects who underwent health examinations at Beijing Tongren Hospital were included in this study. H. pylori infection was determined using 13 C-breath test. The 10-year cardiovascular risk was assessed using the Framingham score. Insulin resistance was evaluated through the triglyceride-glucose (TyG) index and its derivatives. Logistic regression and subgroup analyses were performed to evaluate associations. Results: Individuals with H. pylori infection exhibited significantly higher TyG index and its derivatives (all P < 0.001), indicating increased insulin resistance. All TyG-related indices were strongly correlated with 10-year CVD risk, with TyG-WHR showing the strongest association (R = 0.745, P < 0.001). The estimated 10-year CVD risk was significantly higher in the H. pylori-infected group ( P = 0.003). After adjusting for potential confounders, H. pylori infection remained independently associated with high cardiovascular risk (OR = 2.552, 95% CI: 1.312–4.963, P = 0.006). Notably, this association was more pronounced in females, individuals younger than 50 years, non-smokers, non-diabetics, and those without hypertension. Conclusions: H. pylori infection is associated with increased insulin resistance and elevated 10-year cardiovascular risk, particularly among individuals without traditional risk factors. These findings suggest that H. pylori infection may represent a non-traditional contributor to cardiovascular risk and warrants further investigation. Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Helicobacter pylori ( H. pylori ) infection is one of the most common bacterial infections worldwide, affecting more than half of the global population. In China, the prevalence of H. pylori infection remains notably high, with significant regional variations and an overall prevalence rate exceeding 50% 1 . This widespread infection poses a substantial public health burden. Traditionally, H. pylori has been associated with gastrointestinal diseases, including chronic gastritis, peptic ulcers, and gastric cancer. However, recent research has broadened the scope of diseases linked to H. pylori to include extragastric conditions such as hyperglycemia, hyperlipidemia, and cardiovascular diseases (CVDs), which have garnered significant attention 2 – 4 . CVDs, including cerebrovascular disease, peripheral vascular disease, coronary heart disease, and heart failure, are leading causes of morbidity and mortality worldwide 5 . The Framingham score is a well-established tool used to estimate the 10-year risk of cardiovascular events 6 , and its widespread applicability across diverse populations underscores its importance in cardiovascular risk stratification. Insulin resistance (IR) is a key factor in the pathogenesis of various diseases, including CVD. The triglyceride-glucose (TyG) index serves as an important marker for evaluating insulin resistance. While the hyperinsulinemic-euglycemic clamp remains the gold standard, the TyG index offers greater sensitivity and specificity 7 , 8 . Recent studies suggest that the TyG index and its derivatives—such as TyG × waist-to-hip ratio (TyG-WHR), TyG × waist-to-height ratio (TyG-WHtR), and TyG × body mass index (TyG-BMI)—outperform the TyG index alone in predicting cardiovascular-related mortality 9 . Despite numerous studies exploring the relationship between H. pylori infection and cardiovascular events, the findings have been inconsistent. Some research suggests a significant association, while other studies propose that the observed link may be coincidental or confounded by other factors 10 – 12 . Importantly, most previous studies have focused on populations with established cardiovascular risk factors, such as diabetes or hypertension, potentially obscuring the impact of H. pylori infection in otherwise low-risk individuals. In addition, insulin resistance has been proposed as a potential mechanistic link between H. pylori infection and cardiovascular risk, yet this relationship has not been fully characterized using sensitive surrogate markers such as the TyG index and its derivatives. Therefore, this study aimed to investigate the association between H. pylori infection, insulin resistance, and 10-year cardiovascular risk, with a particular focus on stratified populations, especially individuals without traditional cardiovascular risk factors. Methods Study Population This study recruited adults from the Tongren Health Care Study 13 who underwent physical examinations at Beijing Tongren Hospital, Capital Medical University. The study was approved by Beijing Tongren Hospital Ethics Committee (TRECKY2018-033). Clinical trial number is not applicable. Collected data comprised demographic information (age, sex), smoking status, medical history (diabetes and hypertension), laboratory measurements, and carbon breath test results. Individuals with a history of cancer, severe cardiovascular disease, or gastrointestinal surgery were excluded. A total of 1,398 participants met the inclusion criteria. Anthropometric and Laboratory Measurements Body mass index (BMI) was calculated as weight (kg) divided by height (meters) squared (kg/m²). Waist circumference (WC) was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest using a flexible measuring tape. Hip circumference was measured at the widest part of the buttocks. Blood pressure (BP) was recorded as the average of three measurements taken while the participant was seated. Blood samples were collected after an overnight fast to measure plasma glucose, glycosylated hemoglobin A1c (HbA1c), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), direct bilirubin, total bilirubin, total bile acids, alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), γ-glutamyl transpeptidase (γ-GT), blood urea nitrogen (BUN), serum creatinine (SCr), and uric acid (UA) concentrations. H. pylori infection was detected using the 13 C-breath test, conducted either on an empty stomach or 2 hours post-meal, with a positive result defined as a measurement greater than 4. Assessment of TyG Index and Its Derivatives The TyG index was calculated using the formula: Ln [fasting TG (mg/dL) × fasting glucose (mg/dL) / 2] 8,14 . The following derivatives were calculated: TyG-WHR = TyG × WC / Hip circumference TyG-WHtR = TyG × WC / Height TyG-BMI = TyG × [Body weight (kg) / Height² (m)] Estimation of 10-Year CVD Risk The 10-year CVD risk was estimated using the Framingham risk score, which considers factors such as age, gender, total cholesterol (TC), HDL cholesterol, systolic blood pressure (SBP), treatment for hypertension, smoking status, and diabetes status 6 . Although the Framingham risk score was originally developed in Western populations, it has been widely applied in Asian populations for cardiovascular risk estimation. The score assigns points based on these factors, which are then summed to estimate the 10-year risk of developing cardiovascular events. Cardiovascular risk was categorized as low risk (≤ 10%) or high risk (> 10%). Statistical Analysis Continuous variables are presented as mean ± standard deviation, while categorical variables are expressed as percentages. Statistical significance between H. pylori -infected and non-infected subjects was assessed using independent Student’s t -tests and Chi-square tests. Trend Chi-square tests were applied to compare the distribution of variables grouped into quartiles. Spearman correlation analysis was performed to evaluate correlations between TyG indices and 10-year CVD risk. Binary logistic regression analysis was conducted to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for the 10-year CVD risk associated with H. pylori infection. All P values were two-tailed, with P < 0.05 considered statistically significant. Statistical analyses were conducted using SPSS software, version 24.0 (SPSS Inc., Chicago, IL, USA). Results Clinical Characteristics of the Study Population A total of 1,398 subjects were enrolled in this study, with 658 females (47.07%). The prevalence of H. pylori infection was 24.03% (336 subjects). Table 1 presents the clinical characteristics of subjects with and without H. pylori infection. Notably, the percentage of males was higher in the H. pylori -infected group compared to the non-infected group. The infected group also exhibited significantly larger waist and hip circumferences, higher BMI, and a greater proportion of smokers. Furthermore, subjects with H. pylori infection had poorer blood glucose and lipid profiles, as well as elevated levels of serum creatinine and uric acid (all P 0.05). Table 1 Comparison of clinical characteristics classified by H. pylori infection. Age(years) H. Pylori negative (n = 1062) H. pylori positive (n = 336) P value 42.01 ± 12.64 42.45 ± 13.07 0.575 Waist circumference (cm) 79.31 ± 11.13 82.00 ± 11.72 0.000 Hip circumference (cm) 95.82 ± 6.16 96.94 ± 6.36 0.004 BMI (kg/m 2 ) 23.56 ± 3.54 24.33 ± 3.64 0.001 SBP (mmHg) 124.46 ± 16.29 127.38 ± 17.27 0.005 DBP (mmHg) 76.49 ± 10.56 77.77 ± 11.83 0.061 Female (%) 526 (49.53) 132 (39.29) 0.001 Hypertenssion (%) 118 (11.11) 43 (12.80) 0.399 Smoke (%) 162 (12.26) 79 (23.51) 0.000 Diabetes (%) 50 (4.71) 25 (7.44) 0.053 Fasting blood glucose (mmol/l) 5.33 ± 1.06 5.63 ± 1.67 0.001 HbA1c (%) 5.65 ± 0.60 5.74 ± 0.95 0.063 Total cholesterol (mmol/l) 5.01 ± 0.88 5.15 ± 1.03 0.029 Triglycerides (mmol/l) 1.25 ± 1.02 1.51 ± 1.39 0.001 HDL-C (mmol/l) 1.53 ± 0.40 1.45 ± 0.40 0.003 LDL-C (mmol/l) 2.99 ± 0.78 3.12 ± 0.95 0.024 ALT (U/L) 22.22 ± 16.85 22.93 ± 16.39 0.542 AST (U/L) 22.40 ± 13.92 21.52 ± 7.72 0.322 γ-GT (U/L) 27.90 ± 29.60 28.53 ± 25.88 0.754 BUN (mmol/L) 4.85 ± 1.25 4.97 ± 1.31 0.176 Serum creatinine (µmol/L) 71.59 ± 14.23 75.03 ± 15.52 0.001 Uric acid (µmol/L) 331.32 ± 85.16 351.28 ± 95.80 0.001 Higher TyG Index and Its Derivatives in H. pylori Infected Subjects As shown in Table 2 , subjects with H. pylori infection had significantly higher values for the TyG index and its derivatives (TyG-WHR, TyG-WHtR, and TyG-BMI) compared to non-infected subjects (all P < 0.001). To further explore these differences, the TyG index and its derivatives were divided into quartiles (Q1-Q4), with Q1 representing the lowest values and Q4 the highest. Figure 1 illustrates the distribution of these quartiles between the H. pylori -infected and non-infected groups. In the H. pylori -infected group, a significantly higher proportion of subjects fell into the highest quartile (Q4) for TyG and its derivatives, while a significantly lower proportion fell into the lowest quartile (Q1) (all P trend < 0.05). This distribution suggests that H. pylori infection is associated with elevated TyG index levels and its derivatives, indicating increased insulin resistance among those infected. Table 2 TyG index and its derivatives in subjects with or without H.pylori infection . TyG H. Pylori negative (n = 1062) H. pylori positive (n = 336) P value 8.37 ± 0.65 8.54 ± 0.76 0.000 TyG-WHR 6.92 ± 1.08 7.21 ± 1.28 0.000 TyG-WHtR 3.96 ± 0.72 4.17 ± 0.81 0.000 TyG-BMI 197.72 ± 40.35 208.85 ± 46.79 0.000 TyG and Its Derivatives Are Highly Correlated with 10-Year Cardiovascular Disease Risk The TyG index is a key indicator of insulin sensitivity and plays a significant role in assessing CVD risk. We analyzed the correlation between the TyG index and its derivatives with the 10-year CVD risk calculated using the Framingham risk score. As shown in Fig. 2 , the TyG index and its derivatives were all highly correlated with the 10-year CVD risk. Among these, TyG-WHR (R = 0.745, P < 0.001) and TyG-WHtR (R = 0.701, P < 0.001) exhibited the strongest correlations. These findings demonstrate that higher TyG indices, indicating greater insulin resistance, are associated with an increased 10-year CVD risk. Higher 10-Year CVD Risk in H. pylori Infected Subjects We further compared the 10-year CVD risk between H. pylori -infected and non-infected groups. As shown in Fig. 3 A, the 10-year CVD risk was significantly higher in the H. pylori -infected group ( P = 0.003). Additionally, when the 10-year CVD risk was divided into quartiles, the distribution differed notably between the two groups (Fig. 3 B). A significantly higher proportion of individuals in the H. pylori -infected group fell into the highest quartile for CVD risk compared to the non-infected group ( P = 0.002). This finding indicates that H. pylori infection is associated with an elevated 10-year CVD risk. H. pylori Infection is Independently Associated with High CVD Risk Using the Framingham risk score, we classified subjects into low-risk and high-risk groups with a threshold of 10%. Logistic regression analysis was conducted to determine whether H. pylori infection was independently associated with high CVD risk. As shown in Table 3 , H. pylori infection was significantly associated with high CVD risk. After adjusting for age and sex (Model 2), and further adjusting for diabetes, smoking, and hypertension (Model 3), followed by additional adjustment for BMI and WHR (Model 4), the odds ratios (ORs) remained significant (Model 4: OR = 2.552, 95% CI = 1.312–4.963, P = 0.006). Table 3 Relationship between H. Pylori infection and 10-year CVD risk by logistic regression analysis. H. Pylori infection Odds ratio 95% CI P value Model 1 1.739 1.285–2.353 0.000 Model 2 2.492 1.496–4.415 0.000 Model 3 2.749 1.437–5.257 0.002 Model 4 2.552 1.312–4.963 0.006 Participants were categorized into low-risk and high-risk groups using a 10% Framingham risk score threshold. Model 1: crude; Model 2: adjust for age and sex; Model 3: adjust for age, sex, Diabetes, Smoke, Hypertension. Model 4: adjust for age, sex, Diabetes, Smoke, Hypertension, BMI, WHR. H. pylori Infection is Independently Associated with 10-Year Cardiovascular Risk in Healthy, Younger, Non-Smoking and Female Populations To further explore the association between H. pylori infection and high CVD risk, the study population was stratified into subgroups based on sex, age, smoking status, hypertension, and diabetes. The analysis revealed that H. pylori infection was independently associated with high CVD risk in several subgroups, including females, individuals under 50 years of age, non-smokers, and those without diabetes or hypertension (Fig. 4 ). Notably, these associations were more evident in individuals without traditional cardiovascular risk factors, suggesting that the potential impact of H. pylori infection on cardiovascular risk may be more pronounced in otherwise low-risk populations. Discussion In this study, we found that H. pylori infection was significantly associated with increased insulin resistance and elevated 10-year cardiovascular risk. Notably, this association was more pronounced in individuals without traditional cardiovascular risk factors, including younger, non-diabetic, non-hypertensive, and non-smoking populations. The TyG index and its derivatives are well-established markers of insulin resistance, which is a key factor in the development of cardiovascular events. Our findings demonstrate that all TyG indices are strongly correlated with 10-year CVD risk. Notably, subjects with H. pylori infection exhibited significantly higher levels of the TyG index and its derivatives, indicating greater insulin resistance. Moreover, the 10-year CVD risk, as measured by the Framingham score, was significantly higher in the H. pylori -infected group compared to the non-infected group. Stratified logistic regression analysis further confirmed that H. pylori infection is independently associated with a higher risk of cardiovascular events, particularly in subgroups such as females, younger individuals, non-smokers, non-diabetics, and those without hypertension. This finding suggests that H. pylori infection may act as a non-traditional or early contributor to cardiovascular risk, particularly in otherwise low-risk individuals. Previous studies investigating the relationship between H. pylori infection and CVD risk have yielded conflicting results. Some studies have demonstrated a significant association between H. pylori infection and increased CVD risk 11 , 15 , while others have not found such a connection. For instance, a large cohort study did not observe a significant correlation between H. pylori seropositivity and ischemic heart disease 12 . Additionally, some studies suggest that the evidence for a direct causal link between H. pylori infection and CVDs is inconsistent and may be influenced by confounding factors 10 , 16 . The inconsistencies in previous studies may be attributed to differences in study populations, methodologies, and the presence of confounding variables. Our study addresses some of these limitations by conducting a stratified analysis, which revealed that H. pylori infection is independently associated with high CVD risk, particularly in females, younger individuals, healthy individuals, and non-smokers. This stratified approach may explain why earlier studies failed to detect a significant association, as the impact of H. pylori infection on CVD risk might be more pronounced in these specific subgroups. Our findings suggest that while the influence of H. pylori infection on CVD risk might be less significant compared to traditional risk factors such as hypertension, diabetes, smoking, and age, it still poses a considerable risk in otherwise healthy populations. Therefore, the eradication of H. pylori could have meaningful implications for reducing CVD risk, particularly in these subgroups. The increased CVD risk associated with H. pylori infection can be explained by several mechanisms. Chronic inflammation induced by the infection leads to endothelial dysfunction and atherosclerosis, as the inflammatory response generates reactive oxygen species (ROS) that cause oxidative stress and damage to endothelial cells 17 , 18 . This process is further exacerbated by the immune response, which involves cytokines such as interleukin-6 (IL-6), cyclooxygenase (COX), and tumor necrosis factor-alpha (TNF-α), promoting atherosclerosis 19 – 22 . H. pylori infection also affects lipid metabolism, leading to dyslipidemia, characterized by elevated levels of total cholesterol and triglycerides, and reduced HDL cholesterol, all of which contribute to cardiovascular risk 3 , 23 . These mechanisms collectively contribute to the development and progression of CVD in individuals infected with H. pylori . There are several limitations to our study. First, the cross-sectional design precludes causal inference. Second, the study population was derived from a single center in Beijing, which may limit generalizability. Third, H. pylori virulence factors (e.g., CagA status) were not assessed. Finally, residual confounding factors, such as lifestyle and dietary habits, could not be fully excluded. In conclusion, H. pylori infection is associated with increased insulin resistance and elevated cardiovascular risk, particularly in individuals without traditional risk factors. These findings highlight the potential role of H. pylori infection as a non-traditional cardiovascular risk factor and underscore the need for further prospective studies. Declarations Ethics approval and consent to participate The study was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (TRECKY2018-033). As this was a retrospective study using anonymized data obtained from routine health examinations and involved no additional interventions, the Ethics Committee waived the requirement for additional study-specific informed consent. In addition, as part of the hospital’s standard pre-examination procedure, all individuals undergoing health examinations had signed written informed consent prior to participation, authorizing their examination results and clinical data to be used for scientific research purposes. Therefore, all data used in the present study were covered by the informed consent previously provided by all participants. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from the corresponding author upon reasonable request. Competing interests The authors declare no competing interests. Funding This work was supported by grants from Beijing Municipal Science &Technology Commission (Z151100004015021) to XLZ, the National Natural Science Foundation of China (82341076) to JKY, the National Natural Science Foundation of China (82300917) and the Beijing Municipal Administration of Hospitals Incubating Program (PX20240203) to MMZ. Authors’ contributions XLZ, JKY and MMZ designed this study. DNC, JC, YL and RRX were involved in data collection. WL provided statistical expertise. MMZ analyzed the data and wrote the first draft of the manuscript. XLZ and MMZ contributed to the interpretation and discussion of this study. All authors approved the final version of the manuscript. References Hooi JKY, et al. Global Prevalence of Helicobacter pylori Infection: Systematic Review and Meta-Analysis. Gastroenterology. 2017;153:420–9. 10.1053/j.gastro.2017.04.022 . Sun J, Rangan P, Bhat SS, Liu L. A Meta-Analysis of the Association between Helicobacter pylori Infection and Risk of Coronary Heart Disease from Published Prospective Studies. Helicobacter 21, 11–23. 10.1111/hel.12234 (2016). Zhao M-M, et al. Helicobacter pylori infection as a risk factor for serum bilirubin change and less favourable lipid profiles: a hospital-based health examination survey. BMC Infect Dis. 2019;19:157. 10.1186/s12879-019-3787-8 . Pellicano R, Ianiro G, Fagoonee S, Settanni CR, Gasbarrini A. Review: Extragastric diseases and Helicobacter pylori. Helicobacter. 2020;25(1):e12741. 10.1111/hel.12741 . Di Cesare M, et al. The Heart of the World. 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Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 18 May, 2026 Reviews received at journal 15 May, 2026 Reviews received at journal 05 May, 2026 Reviewers agreed at journal 05 May, 2026 Reviewers agreed at journal 02 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviewers invited by journal 30 Apr, 2026 Editor assigned by journal 30 Apr, 2026 Editor invited by journal 17 Apr, 2026 Submission checks completed at journal 16 Apr, 2026 First submitted to journal 16 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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University","correspondingAuthor":false,"prefix":"","firstName":"Rong-Rong","middleName":"","lastName":"Xie","suffix":""},{"id":636080614,"identity":"bb9eabde-d62a-4cc6-a06c-ac82e9b1b7de","order_by":5,"name":"Dong-Ning Chen","email":"","orcid":"","institution":"Beijing Tongren Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dong-Ning","middleName":"","lastName":"Chen","suffix":""},{"id":636080617,"identity":"1696e8a4-0b75-4640-a24a-fc9f64342dcf","order_by":6,"name":"Jin-Kui Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYBACxh4wZQPlshGvJY0ELQw8YPIwCVqYe84Yfi74dV6ef9oZA4YPZYcZ+Gc3EHBYb4+x9My+24YzbucYMM44d5hB4s4BAlr6eQykeXtuJxhI5xgw87YdZjCQSCCoxfg3b885iJa/RGnp7TGT5vlxAKKFkSgtPcfKrHkbkoF+SSs42HMunUfiBgEthj3Jm2/z/LGT55+dvPHBjzJrOf4ZhLQ0cBgwMLZBOAcYYPGED8gzsD9gYPhDUN0oGAWjYBSMZAAAHvhAcScfOUgAAAAASUVORK5CYII=","orcid":"","institution":"Beijing Diabetes Institute, Capital Medical University","correspondingAuthor":true,"prefix":"","firstName":"Jin-Kui","middleName":"","lastName":"Yang","suffix":""},{"id":636080621,"identity":"35d95332-d919-4513-9064-0af447b872ae","order_by":7,"name":"Xue-Lian Zhang","email":"","orcid":"","institution":"Beijing Tongren Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xue-Lian","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2026-04-03 08:39:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9310779/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9310779/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108806503,"identity":"2504568f-18c1-473c-b0fc-ca2de281ec16","added_by":"auto","created_at":"2026-05-08 15:28:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":192340,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDistribution of TyG index and its derivatives by \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eH. pylori\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e infection status.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDistribution of the TyG index (A), TyG-WHR (B), TyG-WHtR (C), and TyG-BMI (D) divided into quartiles (Q1-Q4) among \u003cem\u003eH. pylori \u003c/em\u003einfected and non-infected subjects.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9310779/v1/bdce2cd8584f34132ecc7529.png"},{"id":108762413,"identity":"6452a8c8-7b99-4987-9c0e-f2d42e5d1f11","added_by":"auto","created_at":"2026-05-08 06:57:43","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":119062,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCorrelation between TyG index and its derivatives with 10-year CVD risk.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eScatter plots showing the correlation between the TyG index (A), TyG-WHR (B), TyG-WHtR (C) and TyG-BMI (D) with 10-year CVD risk, calculated using the Framingham risk score.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9310779/v1/fc234d125e3db213fa9bdc6a.png"},{"id":108807572,"identity":"8d359dd1-bef7-4e77-bc60-fb044735c908","added_by":"auto","created_at":"2026-05-08 15:30:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":34280,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of 10-year CVD risk between \u003c/strong\u003e\u003cem\u003e\u003cstrong\u003eH. pylori\u003c/strong\u003e\u003c/em\u003e\u003cstrong\u003e infected and non-infected subjects.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A) Box plot showing the 10-year CVD risk scores between \u003cem\u003eH. pylori \u003c/em\u003einfected and non-infected groups. Data are presented as mean ± 95% CI. (B) Quartile distribution of 10-year CVD risk scores between \u003cem\u003eH. pylori \u003c/em\u003einfected and non-infected groups.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-9310779/v1/09166494b8dad99d8a207b6a.png"},{"id":108762415,"identity":"a2383f6a-24c1-4f82-80bb-bbaadf3b929a","added_by":"auto","created_at":"2026-05-08 06:57:43","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":97691,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStratified analysis of H. pylori infection and high CVD risk.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLogistic regression analysis of \u003cem\u003eH. pylori \u003c/em\u003einfection and high CVD risk stratified by sex, age, smoking status, and presence of diabetes and hypertension.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-9310779/v1/b6b90099dd8ab7b5bbd33fe8.png"},{"id":108809889,"identity":"88903fee-d9b4-4372-8edc-8e03ad48d3c6","added_by":"auto","created_at":"2026-05-08 15:56:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":647025,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9310779/v1/29f5f5d2-dcaa-4215-b60d-de27a12a82f8.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Helicobacter pylori Infection Is Associated with Elevated Insulin Resistance and Cardiovascular Risk, Particularly in Otherwise Low-Risk Individuals: The Tongren Health Care Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cem\u003eHelicobacter pylori\u003c/em\u003e (\u003cem\u003eH. pylori\u003c/em\u003e) infection is one of the most common bacterial infections worldwide, affecting more than half of the global population. In China, the prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infection remains notably high, with significant regional variations and an overall prevalence rate exceeding 50%\u003csup\u003e1\u003c/sup\u003e. This widespread infection poses a substantial public health burden. Traditionally, \u003cem\u003eH. pylori\u003c/em\u003e has been associated with gastrointestinal diseases, including chronic gastritis, peptic ulcers, and gastric cancer. However, recent research has broadened the scope of diseases linked to \u003cem\u003eH. pylori\u003c/em\u003e to include extragastric conditions such as hyperglycemia, hyperlipidemia, and cardiovascular diseases (CVDs), which have garnered significant attention\u003csup\u003e\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCVDs, including cerebrovascular disease, peripheral vascular disease, coronary heart disease, and heart failure, are leading causes of morbidity and mortality worldwide\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The Framingham score is a well-established tool used to estimate the 10-year risk of cardiovascular events\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e, and its widespread applicability across diverse populations underscores its importance in cardiovascular risk stratification. Insulin resistance (IR) is a key factor in the pathogenesis of various diseases, including CVD. The triglyceride-glucose (TyG) index serves as an important marker for evaluating insulin resistance. While the hyperinsulinemic-euglycemic clamp remains the gold standard, the TyG index offers greater sensitivity and specificity\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Recent studies suggest that the TyG index and its derivatives\u0026mdash;such as TyG \u0026times; waist-to-hip ratio (TyG-WHR), TyG \u0026times; waist-to-height ratio (TyG-WHtR), and TyG \u0026times; body mass index (TyG-BMI)\u0026mdash;outperform the TyG index alone in predicting cardiovascular-related mortality\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDespite numerous studies exploring the relationship between \u003cem\u003eH. pylori\u003c/em\u003e infection and cardiovascular events, the findings have been inconsistent. Some research suggests a significant association, while other studies propose that the observed link may be coincidental or confounded by other factors\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Importantly, most previous studies have focused on populations with established cardiovascular risk factors, such as diabetes or hypertension, potentially obscuring the impact of H. pylori infection in otherwise low-risk individuals. In addition, insulin resistance has been proposed as a potential mechanistic link between \u003cem\u003eH. pylori\u003c/em\u003e infection and cardiovascular risk, yet this relationship has not been fully characterized using sensitive surrogate markers such as the TyG index and its derivatives.\u003c/p\u003e \u003cp\u003eTherefore, this study aimed to investigate the association between \u003cem\u003eH. pylori\u003c/em\u003e infection, insulin resistance, and 10-year cardiovascular risk, with a particular focus on stratified populations, especially individuals without traditional cardiovascular risk factors.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eThis study recruited adults from the Tongren Health Care Study\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e who underwent physical examinations at Beijing Tongren Hospital, Capital Medical University. The study was approved by Beijing Tongren Hospital Ethics Committee (TRECKY2018-033). Clinical trial number is not applicable. Collected data comprised demographic information (age, sex), smoking status, medical history (diabetes and hypertension), laboratory measurements, and carbon breath test results. Individuals with a history of cancer, severe cardiovascular disease, or gastrointestinal surgery were excluded. A total of 1,398 participants met the inclusion criteria.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnthropometric and Laboratory Measurements\u003c/h3\u003e\n\u003cp\u003eBody mass index (BMI) was calculated as weight (kg) divided by height (meters) squared (kg/m\u0026sup2;). Waist circumference (WC) was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest using a flexible measuring tape. Hip circumference was measured at the widest part of the buttocks. Blood pressure (BP) was recorded as the average of three measurements taken while the participant was seated. Blood samples were collected after an overnight fast to measure plasma glucose, glycosylated hemoglobin A1c (HbA1c), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), direct bilirubin, total bilirubin, total bile acids, alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate transaminase (AST), γ-glutamyl transpeptidase (γ-GT), blood urea nitrogen (BUN), serum creatinine (SCr), and uric acid (UA) concentrations. \u003cem\u003eH. pylori\u003c/em\u003e infection was detected using the \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003eC-breath test, conducted either on an empty stomach or 2 hours post-meal, with a positive result defined as a measurement greater than 4.\u003c/p\u003e\n\u003ch3\u003eAssessment of TyG Index and Its Derivatives\u003c/h3\u003e\n\u003cp\u003eThe TyG index was calculated using the formula: Ln [fasting TG (mg/dL) \u0026times; fasting glucose (mg/dL) / 2]\u003csup\u003e8,14\u003c/sup\u003e. The following derivatives were calculated:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTyG-WHR\u003c/b\u003e\u0026thinsp;=\u0026thinsp;TyG \u0026times; WC / Hip circumference\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTyG-WHtR\u003c/b\u003e\u0026thinsp;=\u0026thinsp;TyG \u0026times; WC / Height\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eTyG-BMI\u003c/b\u003e\u0026thinsp;=\u0026thinsp;TyG \u0026times; [Body weight (kg) / Height\u0026sup2; (m)]\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eEstimation of 10-Year CVD Risk\u003c/h3\u003e\n\u003cp\u003eThe 10-year CVD risk was estimated using the Framingham risk score, which considers factors such as age, gender, total cholesterol (TC), HDL cholesterol, systolic blood pressure (SBP), treatment for hypertension, smoking status, and diabetes status\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Although the Framingham risk score was originally developed in Western populations, it has been widely applied in Asian populations for cardiovascular risk estimation. The score assigns points based on these factors, which are then summed to estimate the 10-year risk of developing cardiovascular events. Cardiovascular risk was categorized as low risk (\u0026le;\u0026thinsp;10%) or high risk (\u0026gt;\u0026thinsp;10%).\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, while categorical variables are expressed as percentages. Statistical significance between \u003cem\u003eH. pylori\u003c/em\u003e-infected and non-infected subjects was assessed using independent Student\u0026rsquo;s \u003cem\u003et\u003c/em\u003e-tests and Chi-square tests. Trend Chi-square tests were applied to compare the distribution of variables grouped into quartiles. Spearman correlation analysis was performed to evaluate correlations between TyG indices and 10-year CVD risk. Binary logistic regression analysis was conducted to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for the 10-year CVD risk associated with \u003cem\u003eH. pylori\u003c/em\u003e infection. All \u003cem\u003eP\u003c/em\u003e values were two-tailed, with \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant. Statistical analyses were conducted using SPSS software, version 24.0 (SPSS Inc., Chicago, IL, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eClinical Characteristics of the Study Population\u003c/h2\u003e \u003cp\u003eA total of 1,398 subjects were enrolled in this study, with 658 females (47.07%). The prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infection was 24.03% (336 subjects). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the clinical characteristics of subjects with and without \u003cem\u003eH. pylori\u003c/em\u003e infection. Notably, the percentage of males was higher in the \u003cem\u003eH. pylori\u003c/em\u003e-infected group compared to the non-infected group. The infected group also exhibited significantly larger waist and hip circumferences, higher BMI, and a greater proportion of smokers. Furthermore, subjects with \u003cem\u003eH. pylori\u003c/em\u003e infection had poorer blood glucose and lipid profiles, as well as elevated levels of serum creatinine and uric acid (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences were observed between the two groups in terms of age, liver function, and the prevalence of diabetes and hypertension (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of clinical characteristics classified by \u003cem\u003eH. pylori\u003c/em\u003e infection.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge(years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eH. Pylori\u003c/em\u003e\u003c/p\u003e \u003cp\u003enegative (n\u0026thinsp;=\u0026thinsp;1062)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eH. pylori\u003c/em\u003e\u003c/p\u003e \u003cp\u003epositive (n\u0026thinsp;=\u0026thinsp;336)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.01\u0026thinsp;\u0026plusmn;\u0026thinsp;12.64\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42.45\u0026thinsp;\u0026plusmn;\u0026thinsp;13.07\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaist circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e79.31\u0026thinsp;\u0026plusmn;\u0026thinsp;11.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.00\u0026thinsp;\u0026plusmn;\u0026thinsp;11.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHip circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.82\u0026thinsp;\u0026plusmn;\u0026thinsp;6.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e96.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.33\u0026thinsp;\u0026plusmn;\u0026thinsp;3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124.46\u0026thinsp;\u0026plusmn;\u0026thinsp;16.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127.38\u0026thinsp;\u0026plusmn;\u0026thinsp;17.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDBP (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76.49\u0026thinsp;\u0026plusmn;\u0026thinsp;10.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e77.77\u0026thinsp;\u0026plusmn;\u0026thinsp;11.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e526 (49.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132 (39.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertenssion (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e118 (11.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (12.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.399\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoke (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e162 (12.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (23.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50 (4.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (7.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFasting blood glucose (mmol/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.33\u0026thinsp;\u0026plusmn;\u0026thinsp;1.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.74\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal cholesterol (mmol/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.01\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.029\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglycerides (mmol/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.51\u0026thinsp;\u0026plusmn;\u0026thinsp;1.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDL-C (mmol/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.53\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.45\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDL-C (mmol/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.99\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.024\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.22\u0026thinsp;\u0026plusmn;\u0026thinsp;16.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.93\u0026thinsp;\u0026plusmn;\u0026thinsp;16.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.40\u0026thinsp;\u0026plusmn;\u0026thinsp;13.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.52\u0026thinsp;\u0026plusmn;\u0026thinsp;7.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eγ-GT (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.90\u0026thinsp;\u0026plusmn;\u0026thinsp;29.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.53\u0026thinsp;\u0026plusmn;\u0026thinsp;25.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.754\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBUN (mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.97\u0026thinsp;\u0026plusmn;\u0026thinsp;1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.176\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSerum creatinine (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71.59\u0026thinsp;\u0026plusmn;\u0026thinsp;14.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.03\u0026thinsp;\u0026plusmn;\u0026thinsp;15.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUric acid (\u0026micro;mol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e331.32\u0026thinsp;\u0026plusmn;\u0026thinsp;85.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e351.28\u0026thinsp;\u0026plusmn;\u0026thinsp;95.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eHigher TyG Index and Its Derivatives in\u003c/b\u003e \u003cb\u003eH. pylori\u003c/b\u003e \u003cb\u003eInfected Subjects\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, subjects with \u003cem\u003eH. pylori\u003c/em\u003e infection had significantly higher values for the TyG index and its derivatives (TyG-WHR, TyG-WHtR, and TyG-BMI) compared to non-infected subjects (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). To further explore these differences, the TyG index and its derivatives were divided into quartiles (Q1-Q4), with Q1 representing the lowest values and Q4 the highest. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the distribution of these quartiles between the \u003cem\u003eH. pylori\u003c/em\u003e-infected and non-infected groups. In the \u003cem\u003eH. pylori\u003c/em\u003e-infected group, a significantly higher proportion of subjects fell into the highest quartile (Q4) for TyG and its derivatives, while a significantly lower proportion fell into the lowest quartile (Q1) (all \u003cem\u003eP\u003c/em\u003e trend\u0026thinsp;\u0026lt;\u0026thinsp;0.05). This distribution suggests that \u003cem\u003eH. pylori\u003c/em\u003e infection is associated with elevated TyG index levels and its derivatives, indicating increased insulin resistance among those infected.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eTyG index and its derivatives in subjects with or without \u003cem\u003eH.pylori\u003c/em\u003e infection .\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTyG\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eH. Pylori\u003c/em\u003e\u003c/p\u003e \u003cp\u003enegative (n\u0026thinsp;=\u0026thinsp;1062)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eH. pylori\u003c/em\u003e\u003c/p\u003e \u003cp\u003epositive (n\u0026thinsp;=\u0026thinsp;336)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.65\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.54\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTyG-WHR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e6.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e7.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTyG-WHtR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e3.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e4.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTyG-BMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e197.72\u0026thinsp;\u0026plusmn;\u0026thinsp;40.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e208.85\u0026thinsp;\u0026plusmn;\u0026thinsp;46.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTyG and Its Derivatives Are Highly Correlated with 10-Year Cardiovascular Disease Risk\u003c/h3\u003e\n\u003cp\u003eThe TyG index is a key indicator of insulin sensitivity and plays a significant role in assessing CVD risk. We analyzed the correlation between the TyG index and its derivatives with the 10-year CVD risk calculated using the Framingham risk score. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the TyG index and its derivatives were all highly correlated with the 10-year CVD risk. Among these, TyG-WHR (R\u0026thinsp;=\u0026thinsp;0.745, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and TyG-WHtR (R\u0026thinsp;=\u0026thinsp;0.701, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) exhibited the strongest correlations. These findings demonstrate that higher TyG indices, indicating greater insulin resistance, are associated with an increased 10-year CVD risk.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eHigher 10-Year CVD Risk in\u003c/b\u003e \u003cb\u003eH. pylori\u003c/b\u003e \u003cb\u003eInfected Subjects\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe further compared the 10-year CVD risk between \u003cem\u003eH. pylori\u003c/em\u003e-infected and non-infected groups. As shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA, the 10-year CVD risk was significantly higher in the \u003cem\u003eH. pylori\u003c/em\u003e-infected group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). Additionally, when the 10-year CVD risk was divided into quartiles, the distribution differed notably between the two groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB). A significantly higher proportion of individuals in the \u003cem\u003eH. pylori\u003c/em\u003e-infected group fell into the highest quartile for CVD risk compared to the non-infected group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002). This finding indicates that \u003cem\u003eH. pylori\u003c/em\u003e infection is associated with an elevated 10-year CVD risk.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eH. pylori\u003c/b\u003e \u003cb\u003eInfection is Independently Associated with High CVD Risk\u003c/b\u003e\u003c/p\u003e \u003cp\u003eUsing the Framingham risk score, we classified subjects into low-risk and high-risk groups with a threshold of 10%. Logistic regression analysis was conducted to determine whether \u003cem\u003eH. pylori\u003c/em\u003e infection was independently associated with high CVD risk. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, H. \u003cem\u003epylori\u003c/em\u003e infection was significantly associated with high CVD risk. After adjusting for age and sex (Model 2), and further adjusting for diabetes, smoking, and hypertension (Model 3), followed by additional adjustment for BMI and WHR (Model 4), the odds ratios (ORs) remained significant (Model 4: OR\u0026thinsp;=\u0026thinsp;2.552, 95% CI\u0026thinsp;=\u0026thinsp;1.312\u0026ndash;4.963, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between \u003cem\u003eH. Pylori\u003c/em\u003e infection and 10-year CVD risk by logistic regression analysis.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eH. Pylori\u003c/em\u003e infection\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.739\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.285\u0026ndash;2.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.492\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.496\u0026ndash;4.415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.437\u0026ndash;5.257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.312\u0026ndash;4.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eParticipants were categorized into low-risk and high-risk groups using a 10% Framingham risk score threshold. Model 1: crude; Model 2: adjust for age and sex; Model 3: adjust for age, sex, Diabetes, Smoke, Hypertension. Model 4: adjust for age, sex, Diabetes, Smoke, Hypertension, BMI, WHR.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eH. pylori\u003c/b\u003e \u003cb\u003eInfection is Independently Associated with 10-Year Cardiovascular Risk in Healthy, Younger, Non-Smoking and Female Populations\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo further explore the association between \u003cem\u003eH. pylori\u003c/em\u003e infection and high CVD risk, the study population was stratified into subgroups based on sex, age, smoking status, hypertension, and diabetes. The analysis revealed that \u003cem\u003eH. pylori\u003c/em\u003e infection was independently associated with high CVD risk in several subgroups, including females, individuals under 50 years of age, non-smokers, and those without diabetes or hypertension (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Notably, these associations were more evident in individuals without traditional cardiovascular risk factors, suggesting that the potential impact of \u003cem\u003eH. pylori\u003c/em\u003e infection on cardiovascular risk may be more pronounced in otherwise low-risk populations.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we found that \u003cem\u003eH. pylori\u003c/em\u003e infection was significantly associated with increased insulin resistance and elevated 10-year cardiovascular risk. Notably, this association was more pronounced in individuals without traditional cardiovascular risk factors, including younger, non-diabetic, non-hypertensive, and non-smoking populations. The TyG index and its derivatives are well-established markers of insulin resistance, which is a key factor in the development of cardiovascular events. Our findings demonstrate that all TyG indices are strongly correlated with 10-year CVD risk. Notably, subjects with \u003cem\u003eH. pylori\u003c/em\u003e infection exhibited significantly higher levels of the TyG index and its derivatives, indicating greater insulin resistance. Moreover, the 10-year CVD risk, as measured by the Framingham score, was significantly higher in the \u003cem\u003eH. pylori\u003c/em\u003e-infected group compared to the non-infected group. Stratified logistic regression analysis further confirmed that \u003cem\u003eH. pylori\u003c/em\u003e infection is independently associated with a higher risk of cardiovascular events, particularly in subgroups such as females, younger individuals, non-smokers, non-diabetics, and those without hypertension. This finding suggests that \u003cem\u003eH. pylori\u003c/em\u003e infection may act as a non-traditional or early contributor to cardiovascular risk, particularly in otherwise low-risk individuals.\u003c/p\u003e \u003cp\u003ePrevious studies investigating the relationship between \u003cem\u003eH. pylori\u003c/em\u003e infection and CVD risk have yielded conflicting results. Some studies have demonstrated a significant association between \u003cem\u003eH. pylori\u003c/em\u003e infection and increased CVD risk\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e, while others have not found such a connection. For instance, a large cohort study did not observe a significant correlation between \u003cem\u003eH. pylori\u003c/em\u003e seropositivity and ischemic heart disease\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Additionally, some studies suggest that the evidence for a direct causal link between \u003cem\u003eH. pylori\u003c/em\u003e infection and CVDs is inconsistent and may be influenced by confounding factors\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe inconsistencies in previous studies may be attributed to differences in study populations, methodologies, and the presence of confounding variables. Our study addresses some of these limitations by conducting a stratified analysis, which revealed that \u003cem\u003eH. pylori\u003c/em\u003e infection is independently associated with high CVD risk, particularly in females, younger individuals, healthy individuals, and non-smokers. This stratified approach may explain why earlier studies failed to detect a significant association, as the impact of \u003cem\u003eH. pylori\u003c/em\u003e infection on CVD risk might be more pronounced in these specific subgroups. Our findings suggest that while the influence of \u003cem\u003eH. pylori\u003c/em\u003e infection on CVD risk might be less significant compared to traditional risk factors such as hypertension, diabetes, smoking, and age, it still poses a considerable risk in otherwise healthy populations. Therefore, the eradication of \u003cem\u003eH. pylori\u003c/em\u003e could have meaningful implications for reducing CVD risk, particularly in these subgroups.\u003c/p\u003e \u003cp\u003eThe increased CVD risk associated with \u003cem\u003eH. pylori\u003c/em\u003e infection can be explained by several mechanisms. Chronic inflammation induced by the infection leads to endothelial dysfunction and atherosclerosis, as the inflammatory response generates reactive oxygen species (ROS) that cause oxidative stress and damage to endothelial cells\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. This process is further exacerbated by the immune response, which involves cytokines such as interleukin-6 (IL-6), cyclooxygenase (COX), and tumor necrosis factor-alpha (TNF-α), promoting atherosclerosis\u003csup\u003e\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. \u003cem\u003eH. pylori\u003c/em\u003e infection also affects lipid metabolism, leading to dyslipidemia, characterized by elevated levels of total cholesterol and triglycerides, and reduced HDL cholesterol, all of which contribute to cardiovascular risk\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. These mechanisms collectively contribute to the development and progression of CVD in individuals infected with \u003cem\u003eH. pylori\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eThere are several limitations to our study. First, the cross-sectional design precludes causal inference. Second, the study population was derived from a single center in Beijing, which may limit generalizability. Third, \u003cem\u003eH. pylori\u003c/em\u003e virulence factors (e.g., CagA status) were not assessed. Finally, residual confounding factors, such as lifestyle and dietary habits, could not be fully excluded.\u003c/p\u003e \u003cp\u003eIn conclusion, \u003cem\u003eH. pylori\u003c/em\u003e infection is associated with increased insulin resistance and elevated cardiovascular risk, particularly in individuals without traditional risk factors. These findings highlight the potential role of \u003cem\u003eH. pylori\u003c/em\u003e infection as a non-traditional cardiovascular risk factor and underscore the need for further prospective studies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Ethics Committee of Beijing Tongren Hospital, Capital Medical University (TRECKY2018-033). As this was a retrospective study using anonymized data obtained from routine health examinations and involved no additional interventions, the Ethics Committee waived the requirement for additional study-specific informed consent. In addition, as part of the hospital\u0026rsquo;s standard pre-examination procedure, all individuals undergoing health examinations had signed written informed consent prior to participation, authorizing their examination results and clinical data to be used for scientific research purposes. Therefore, all data used in the present study were covered by the informed consent previously provided by all participants. All procedures involving human participants were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by grants from Beijing Municipal Science \u0026amp;Technology Commission (Z151100004015021) to XLZ, the National Natural Science Foundation of China (82341076) to JKY, the National Natural Science Foundation of China (82300917) and the Beijing Municipal Administration of Hospitals Incubating Program (PX20240203) to MMZ.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eXLZ, JKY and MMZ designed this study. 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Helicobacter pylori infection induces gastric precancerous lesions and persistent expression of Angpt2, Vegf-A and Tnf-A in a mouse model. Front Oncol. 2023;13:1072802. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fonc.2023.1072802\u003c/span\u003e\u003cspan address=\"10.3389/fonc.2023.1072802\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark Y, et al. Eradication of Helicobacter pylori infection decreases risk for dyslipidemia: A cohort study. Helicobacter. 2021;26:e12783. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/hel.12783\u003c/span\u003e\u003cspan address=\"10.1111/hel.12783\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-9310779/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9310779/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground and Objectives:\u003c/p\u003e \u003cp\u003e \u003cem\u003eHelicobacter pylori\u003c/em\u003e (\u003cem\u003eH. pylori\u003c/em\u003e) has been increasingly linked to extragastric conditions. However, the relationship between \u003cem\u003eH. pylori\u003c/em\u003e infection and cardiovascular diseases (CVD) remains controversial. This study aims to investigate the association between \u003cem\u003eH. pylori\u003c/em\u003e infection and 10-year cardiovascular risk.\u003c/p\u003e \u003cp\u003eMethods:\u003c/p\u003e \u003cp\u003eA total of 1,398 subjects who underwent health examinations at Beijing Tongren Hospital were included in this study. \u003cem\u003eH. pylori\u003c/em\u003e infection was determined using \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003eC-breath test. The 10-year cardiovascular risk was assessed using the Framingham score. Insulin resistance was evaluated through the triglyceride-glucose (TyG) index and its derivatives. Logistic regression and subgroup analyses were performed to evaluate associations.\u003c/p\u003e \u003cp\u003eResults:\u003c/p\u003e \u003cp\u003eIndividuals with H. pylori infection exhibited significantly higher TyG index and its derivatives (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001), indicating increased insulin resistance. All TyG-related indices were strongly correlated with 10-year CVD risk, with TyG-WHR showing the strongest association (R\u0026thinsp;=\u0026thinsp;0.745, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The estimated 10-year CVD risk was significantly higher in the H. pylori-infected group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). After adjusting for potential confounders, \u003cem\u003eH. pylori\u003c/em\u003e infection remained independently associated with high cardiovascular risk (OR\u0026thinsp;=\u0026thinsp;2.552, 95% CI: 1.312\u0026ndash;4.963, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006). Notably, this association was more pronounced in females, individuals younger than 50 years, non-smokers, non-diabetics, and those without hypertension.\u003c/p\u003e \u003cp\u003eConclusions:\u003c/p\u003e \u003cp\u003e \u003cem\u003eH. pylori\u003c/em\u003e infection is associated with increased insulin resistance and elevated 10-year cardiovascular risk, particularly among individuals without traditional risk factors. These findings suggest that \u003cem\u003eH. pylori\u003c/em\u003e infection may represent a non-traditional contributor to cardiovascular risk and warrants further investigation.\u003c/p\u003e","manuscriptTitle":"Helicobacter pylori Infection Is Associated with Elevated Insulin Resistance and Cardiovascular Risk, Particularly in Otherwise Low-Risk Individuals: The Tongren Health Care Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-08 06:57:26","doi":"10.21203/rs.3.rs-9310779/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-18T10:24:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T12:07:27+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T23:58:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"66896490752627365437998697555847686765","date":"2026-05-05T10:39:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253761934059891964066875145838689670762","date":"2026-05-02T16:10:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"206098031599797667033289635498653793069","date":"2026-04-30T10:27:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-30T08:33:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-30T04:10:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-17T10:58:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-17T02:40:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2026-04-17T02:35:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33b90148-453c-4e54-9bd8-a75d5a691680","owner":[],"postedDate":"May 8th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-18T10:24:24+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-15T12:07:27+00:00","index":203,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-05T23:58:53+00:00","index":199,"fulltext":""},{"type":"reviewerAgreed","content":"66896490752627365437998697555847686765","date":"2026-05-05T10:39:38+00:00","index":197,"fulltext":""},{"type":"reviewerAgreed","content":"253761934059891964066875145838689670762","date":"2026-05-02T16:10:36+00:00","index":191,"fulltext":""},{"type":"reviewerAgreed","content":"206098031599797667033289635498653793069","date":"2026-04-30T10:27:53+00:00","index":117,"fulltext":""},{"type":"reviewersInvited","content":"141","date":"2026-04-30T08:33:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-30T04:10:12+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T10:39:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-08 06:57:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9310779","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9310779","identity":"rs-9310779","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}