Helicobacter pylori infection and association with chronic diseases: A focus on cardiovascular disease, MASLD, and type 2 diabetes

Abstract

Helicobacter pylori (H. pylori) infection is a globally prevalent gastrointestinal pathogen increasingly linked to various extra-gastric non-communicable diseases (NCDs). This review addresses the guiding question: What epidemiological and mechanistic links explain the association between H. pylori infection and chronic conditions such as cardiovascular disease (CVD), metabolic dysfunction-associated steatotic liver disease (MASLD), and type 2 diabetes mellitus (T2DM)?

The manuscript synthesizes evidence from epidemiological studies and mechanistic research. In CVD, H. pylori exacerbates chronic vascular inflammation, endothelial dysfunction, and autoimmune-like responses such as molecular mimicry. In MASLD, H. pylori induces insulin resistance (IR), hepatic inflammation, and microbiota-mediated liver injury, although findings remain inconclusive across populations. For T2DM, multiple pathways including NLRP3 inflammasome activation, hormonal imbalances (e.g., ghrelin, leptin), and immune-genetic interactions involving TLR4 and SOCS3 suggest a role for H. pylori in metabolic dysregulation and impaired glycemic control. While researchers have not yet fully elucidated causality, these findings indicate H. pylori as a potential modifiable risk factor for NCDs. Future longitudinal and interventional studies are warranted to determine whether eradication of H. pylori can mitigate chronic disease.