Periodontal Disease and Coronary Heart Disease A Reappraisal of the Exposure
ABSTRACT Results from studies relating periodontal disease to cardiovascular disease have been mixed. Residual confounding by smoking and use of clinical measures of periodontal disease rather than measures of infection have been 2 major criticisms. The aims of this study were to investigate relationships between prevalent coronary heart disease (CHD) and 2 exposures, (1) clinical periodontal disease and (2) IgG antibodies to 17 oral organisms, and to evaluate the role of smoking in these relationships.
Our study is based on a subset of participants in the Atherosclerosis Risk in Communities (ARIC) Study, who received a complete periodontal examination during visit 4 (1996-1998). The exposures were periodontal status and serum IgG antibody levels against 17 periodontal organisms, and the outcome was prevalent CHD at visit 4. Multivariable analyses indicate that periodontal status is not significantly associated with CHD in either ever smokers or never smokers. Similar analyses evaluating antibodies indicate that high antibodies (above the median) to Treponema denticola (odds ratio [OR]=1.7; 95% CI, 1.2 to 2.3), Prevotella intermedia (OR=1.5; 95% CI, 1.1 to 2.0), Capnocytophaga ochracea (OR=1.5; 95% CI, 1.1 to 2.1), and Veillonella parvula (OR=1.7; 95% CI, 1.2 to 2.3) are significantly associated with CHD among ever smokers, whereas Prevotella nigrescens (OR=1.7; 95% CI, 1.1 to 2.6), Actinobacillus actinomycetemcomitans (OR=1.7; 95% CI, 1.2 to 2.7), and Capnocytophaga ochracea (OR=2.0; 95% CI, 1.3 to 3.0) were associated with CHD among never smokers.
Clinical signs of periodontal disease were not associated with CHD, whereas systemic antibody response was associated with CHD in ever smokers and never smokers. These findings indicate that the quality and quantity of the host response to oral bacteria may be an exposure more relevant to systemic atherothrombotic coronary events than clinical measures.
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ABSTRACT: It remains unclear whether serum antibody titer against Porphyromonas gingivalis (Pg) and inflammatory components lead to periodontal deterioration in each gender, as periodontal and systemic status is influenced by gender. The present study investigates the gender-specific probable effects of titer against Pg and inflammatory markers on periodontal health status in a longitudinal study. A retrospective study design was used. At two time points over an 8-year period (in 2003 and 2011), 411 individuals (295 males with a mean age of 57.6 ± 11.2 years and 116 females with a mean age of 59.2 ± 10.3 years) were surveyed. Periodontal status, serum antibody titer against Pg, and high-sensitive C-reactive protein (hsCRP) were evaluated. Poisson regression analyses revealed that the elevated titer against Pg and hsCRP significantly predicted the persistence of periodontal disease 8 years later in females with periodontal disease in 2003. Elevated hsCRP was significantly associated with the incidence of periodontal disease 8 years later in females who were periodontally healthy in 2003. Males had a weaker association among titer against Pg, inflammatory markers, and periodontal disease. These findings suggest that immune response to Pg infection in addition to inflammatory components affects periodontal deterioration in females.BioMed Research International 01/2015; 2015. DOI:10.1155/2015/897971 · 2.71 Impact Factor
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ABSTRACT: Abstract Objectives: The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. Methods: Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. Results: Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease).All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. Conclusions: There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events.Journal of Periodontology 04/2013; 84(4 Suppl):S70-84. DOI:10.1902/jop.2013.134008 · 2.57 Impact Factor
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ABSTRACT: Evidence is accumulating that oral bacteria are associated with myocardial infarctions (MI). We were interested in studying the differences in the association between single bacteria or bacteria in combination and the relation to C-reactive protein (CRP). We examined the levels of antibodies against four major periodontal pathogens Porphyromonas gingivalis (PG), Aggregatibacter actinomycetemcomitans (AA), Tannerella forsythia (TF) and Treponema denticola (TD) and CRP in 548 men with a self-reported history of MI to 625 controls who took part in the Oslo II study in 2000. The mean levels of bacterial antibodies were higher for the cases than the controls, but not significant as standard deviations were large. The level of CRP was higher in the cases than the controls (p=0.010). Logistic regression analyses comparing the upper quartile value with the lower value of one of either four antibodies (anti-AA, anti-TF, anti-TD and anti-PG) were significantly associated (p=0.032) with MI. Equivalent analyses of either three bacteria showed significant associations for anti-AA, anti-TD and anti-PG (p=0.036) and anti-AA, anti-PG and anti-TF (p=0.040). CRP showed an increased relative risk with increasing quartile value; trend, p=0.016, but not in multivariate analysis including the oral antigens. No single bacterium but rather combinations were related to increasing relative risk for MI independent of known cardiovascular risk factors.Journal Of Clinical Periodontology 07/2008; 35(6):473-8. DOI:10.1111/j.1600-051X.2008.01229.x · 3.61 Impact Factor