Periodontal Disease and Coronary Heart Disease A Reappraisal of the Exposure

Department of Dental Ecology, University of North Carolina at Chapel Hill, North Carolina, United States
Circulation (Impact Factor: 14.95). 08/2005; 112(1):19-24. DOI: 10.1161/CIRCULATIONAHA.104.511998
Source: PubMed

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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    • ". An elevated serum antibody titer against Pg was defined as having a value greater than median value [24] "
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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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    • "This is in contrast to studies on PD prevalence, where for example the underestimation of prevalence associated with partialmouth recording protocols is well established (Eke et al. 2010). Second, in the context of PD and systemic disease associations, the comparison of results with different PD measures and/or classification criteria may give insight into the underlying mechanisms (Beck et al. 2005). For example, many papers make reference to the fact that the area of the periodontal wound, that is, the ulcerated pocket epithelium is 8– 20 cm 2 (Hujoel et al. 2001b). "
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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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    • "Therefore, targeting of host erythrocytes by A. actinomycetemcomitans may be a crucial step in the pathogenic process and 12 P. S. Munksgaard et al. understanding this interaction could lead to novel therapeutic modalities. Interestingly, recent research suggests that A. actinomycetemcomitans may also be associated with cardiovascular disease (Haraszthy et al., 2000b; Pussinen et al., 2003; Beck et al., 2005; Kozarov et al., 2005), further emphasizing the importance of understanding how this bacterium causes cell damage. Our present findings add new aspects to the essential mechanism of A. actinomycetemcomitans inflicted cell damage. "
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    Cellular Microbiology 08/2012; DOI:10.1111/cmi.12021 · 4.82 Impact Factor
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