A generation or so ago most people believed that ulcers and heart attacks were mainly due to stress. Antacids and the Sippy diet [lots of milk and cream] was the treatment of choice for ulcer patients.Research that started with a hunch by Australian researchers revolutionized ulcer treatment by showing conclusively that most ulcers had little to do with stress or spicy foods and everything to do with a nasty little bacteria named Helicobacter pylori.Antibiotics are now the treatment of choice of ulcers [both gastric and duodenal] and unlike antacids and acid blockers they treat the cause of the disease rather than the symptom.A study by Italian researchers recently showed an association between a more virulent strain of Helicobacter pylori and ischemic heart disease (IHD)[Pasceri V. et al Circulation 1998:97:1675-79].Dr. Pasceri results suggest that this bacteria may increase the risk of a heart attack by causing a persistent low grade inflammatory process that may speed up the atherosclerosis process. Patients who tested positive for this strain of the bacteria were 3.8 times more likely to suffer a heart attack. Perhaps patients with evidence of atherosclerosis and a history of recurrent ulcers and/or gastritis [not traced to NSAIDs] should be tested for Helicobacter pylori infection.However, it is important to note that in rural China where Helicobacter pylori infections are far more common that in America (due to poorer sanatation) the incidence of IHD is also much lower - no doubt because they eat a diet that keeps most of their LDL-C levels well below 100mg/dl.So just as Japanese men who smoked and had HTN rarely suffered from IHD back in the 1960s because their diet kept their LDL-C low, it is again clear that other risk factors for atherosclerosis and CHD are of minor and secondary import compared to a high total and LDL-C level.By James J. Kenney, PhD, RD, FACN.