Age-Dependent Associations Between Chronic Periodontitis/Edentulism and Risk of Coronary Heart Disease

Abstract

Background-Several epidemiological studies have suggested periodontitis as a risk factor for coronary heart disease (CHD), but results have been inconsistent. Methods and Results-We evaluated the association between clinical and radiographic measures of periodontitis, edentulism, and incident CHD (angina, myocardial infarction, or fatal CHD) among 1203 men in the VA Normative Aging and Dental Longitudinal Studies who were followed up with triennial comprehensive medical and dental examinations up to 35 years (median 24 years). Cox proportional hazards models with time-varying effects of exposure and potential confounders were fit. We found a significant dose-dependent association between periodontitis and CHD incidence among men Ͻ60 years of age (hazard ratio 2.12, 95% confidence interval 1.26 to 3.60 comparing highest versus lowest category of radiographic bone loss, P for trendϭ0.02), independent of age, body mass index, smoking, alcohol intake, diabetes mellitus, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, hypertension, systolic and diastolic blood pressure, education, marital status, income, and occupation. No association was found among men Ͼ60 years of age. Similar results were found when the sum of probing pocket depths was used as a measure of periodontitis. Among men Ն60 years of age, edentulous men tended to have a higher risk of CHD than dentate men in the lowest bone loss (hazard ratio 1.61, 95% confidence interval 0.95 to 2.73) and lowest pocket depth (hazard ratio 1.72, 95% confidence interval 1.03 to 2.85) categories, independent of confounders. Conclusions-Chronic periodontitis is associated with incidence of CHD among younger men, independent of established cardiovascular risk factors. (Circulation. 2008;117:1668-1674.)

Periodontal Disease and its Association with Angiographically Verified Coronary Artery Disease

“…Common risk factors such as diabetes mellitus, smoking, genetics, stress, depression, physical inactivity and obesity make it difficult to positively associate periodontitis and CHD (10,11). However, studies have shown such association regardless of common risk factors to be possible (12)(13)(14). Moreover, recent meta-analyses established periodontitis as a risk factor, or as a marker independent of traditional CAD risk factors, for CHD with relative risks ranging from 1.24 to 1.35 (15).…”

Phylogenetic and functional gene structure shifts of the oral microbiomes in periodontitis patients

“…Periodontitis is the leading cause of tooth loss worldwide (Petersen et al, 2005;Pihlstrom et al, 2005). Furthermore, it has been proven to be a significant risk factor of systematic diseases, including coronary heart disease (Dietrich et al, 2008), stroke (Sfyroeras et al, 2012), obesity (Suvan et al, 2011), atherosclerosis (Tonetti, 2009), preterm birth and low birth weight in infants (Rakoto-Alson et al, 2009).…”

Mechanisms of Periodontitis - Induced Atherosclerosis

“…In many epidemiological studies, periodontitis was proven to play important roles in initiation and progression of CVD, [69,70] by chronic infection on the blood vessels [20][21][22][23][24][25][26][27][28][29] or by the elevation of body�s CRP level. [29][30][31][32][33][34][35][36][37][38][39] The prevalence of chronic periodontitis was very high among populations, especially in chronic form.…”

“…[75] Chronic infection was known to be able to cause endothelial dysfunction. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] PG�s fimbriae secretes protein, called gp130, [83] which facilitate PG to invade EC and trigger celluler immune response. [84] The host will secrete TNF, [85] IL-1, IL-6, IL-10, and IL-12 [86][87][88] by TLR�s stimulation.…”

“…[19,20] Atherosclerosis had been proven to be induced by periodontopathogen from periodontitis. [21][22][23][24][25][26][27][28] Inflammation in mouth may cause systemic inflammation, which is indicated by the elevation of CRP in the body, [29,30] which is functioned as markers, [31,32] predictors of CVD, [33,34] and may induce atherosclerosis lesions. [35][36][37][38] Focal infection in mouth may induce atherosclerosis lesions by initiate systemic and humoral immune responses.…”