In terms of the pathogenesis of cardiovascular disease (CVD) the focus has traditionally been on dyslipidemia. Over the decades our understanding of the pathogenesis of CVD has increased, and infections, including those caused by oral bacteria, are more likely involved in CVD progression than previously thought. While many studies have now shown an association between periodontal disease and CVD, the mechanisms underpinning this relationship remain unclear. This review gives a brief overview of the host-bacterial interactions in periodontal disease and virulence factors of oral bacteria before discussing the proposed mechanisms by which oral bacterial may facilitate the progression of CVD.

Aim To determine the relationship between periodontal pathogen load and anti‐human heat shock protein 60 (hHSP60) antibodies in patients with established cardiovascular disease (CVD). Materials and Methods Participants were cardiovascular patients (n = 74) with a previous hospital admission for myocardial infarction. Concurrent periodontal pathogen load of Porphyromonas gingivalis, Fusobacterium nucleatum, Tannerella forsythia and Aggregatibacter actinomycetemcomitans was determined using quantitative real‐time PCR. Serum antibodies to these pathogens, GroEL and hHSP60 were determined using an ELISA. Results There was a trend for increasing anti‐hHSP60 antibody as the number of bacterial species increased. The strongest positive correlations were found between anti‐hHSP60 levels and numbers of T. forsythia (r = 0.43; p < 0.001) and between anti‐hHSP60 and anti‐GroEL levels (r = 0.39; p = 0.001). Patients with extensive periodontal pocketing (≥4 mm) had higher numbers of P. gingivalis and T. forsythia (p < 0.05) and a higher subgingival pathogen load (p < 0.05) than patients with minimal pocketing (≤1 site ≥ 4 mm). They also had significantly elevated anti‐hHSP60 levels (p < 0.05). Overall, the highest anti‐hHSP60 levels were seen in patients with extensive periodontal pocketing and all four bacterial species. Conclusions In cardiovascular patients, a greater burden of subgingival infection with increased levels of P. gingivalis and T. forsythia is associated with modestly higher anti‐hHSP60 levels.

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