Title: A nationwide cohort study suggests clarithromycin-based therapy for Helicobacter pylori
eradication is safe in patients with stable coronary heart disease and subsequent peptic ulcer
disease
Version: 1 Date: 29 May 2022
Reviewer:  giuseppe losurdo
Reviewer's report:
In this retrospective cohort Taiwanese study, Chen et al showed that use of clarithromycin for
H. pylori therapy did not affect overall mortality and cardiovascular mortality and morbidity.
Main comments:
1) Authors did not specify the dose of clarithromycin, nor the duration of eradications therapy
(10 days in all cases?). These could be confounders as well.
2) Clarithromycin may prolong QT interval. However, in the analysis it was not discriminated
morbidity or mortality due to arrhythmia rather than ischemic disease. This sub-analysis should
be added to shed a new light on the study.
3) H. pylori has been linked to atherosclerosis as well and even to ischemic heart disease (see
Ribaldone DG et al, Minerva Gastroenterol Dietol 2016), and this aspect should be discussed.
4) H. pylori should be always italicized.
Title: A nationwide cohort study suggests clarithromycin-based therapy for Helicobacter pylori
eradication is safe in patients with stable coronary heart disease and subsequent peptic ulcer
disease
Version: 1 Date: 29 May 2022
Reviewer:  giuseppe losurdo
Reviewer's report:
In this retrospective cohort Taiwanese study, Chen et al showed that use of clarithromycin for
H. pylori therapy did not affect overall mortality and cardiovascular mortality and morbidity.
Main comments:
1) Authors did not specify the dose of clarithromycin, nor the duration of eradications therapy
(10 days in all cases?). These could be confounders as well.
2) Clarithromycin may prolong QT interval. However, in the analysis it was not discriminated
morbidity or mortality due to arrhythmia rather than ischemic disease. This sub-analysis should
be added to shed a new light on the study.
3) H. pylori has been linked to atherosclerosis as well and even to ischemic heart disease (see
Ribaldone DG et al, Minerva Gastroenterol Dietol 2016), and this aspect should be discussed.
4) H. pylori should be always italicized.
Please review this paper.
user
Title: A nationwide cohort study suggests clarithromycin-based therapy for Helicobacter pylori
eradication is safe in patients with stable coronary heart disease and subsequent peptic ulcer
disease
Version: 1 Date: 29 May 2022
Reviewer:  giuseppe losurdo
Reviewer's report:
In this retrospective cohort Taiwanese study, Chen et al showed that use of clarithromycin for
H. pylori therapy did not affect overall mortality and cardiovascular mortality and morbidity.
Main comments:
1) Authors did not specify the dose of clarithromycin, nor the duration of eradications therapy
(10 days in all cases?). These could be confounders as well.
2) Clarithromycin may prolong QT interval. However, in the analysis it was not discriminated
morbidity or mortality due to arrhythmia rather than ischemic disease. This sub-analysis should
be added to shed a new light on the study.
3) H. pylori has been linked to atherosclerosis as well and even to ischemic heart disease (see
Ribaldone DG et al, Minerva Gastroenterol Dietol 2016), and this aspect should be discussed.
4) H. pylori should be always italicized.
assistant