Cholesterol, C-Reactive Protein, and Periodontitis: HMG-CoA-Reductase Inhibitors (Statins) as Effect Modifiers

Abstract

Common risk factors of periodontitis and cardiovascular diseases fuel the debate on interrelationships between them. The aim is to prove whether statins may influence periodontal parameters by affecting either of these factors. Out of the 4,290 subjects of SHIP (Study of Health in Pomerania), we included subjects aged >30 years (219 with statins, 2937 without) and excluded edentulous. We determined periodontal measures, cholesterol fractions, and inflammation markers. Statin use and periodontal risk factors were assessed. Gingival plaque and periodontal attachment loss were associated with systemic LDL cholesterol (P < 0.001) and C-reactive protein CRP (P = 0.019) revealing interaction with statin use. When adjusted for age, sex, smoking, diabetes, education, and dental service, statins were identified as effect modifiers abolishing the relationship between attachment loss and LDL and between gingival plaque and LDL (interactions P < 0.001). No statin-related interaction was detected with increase in CRP. The interaction supports the view of inter-relationships between periodontal and systemic inflammatory mediators.

Pleiotropic effects of statins on the treatment of chronic periodontitis – a systematic review

“…From the selected studies, five were controlled and randomized clinical trials and six were cohort studies . Generally, the primary outcome analyzed was the probing depth or the clinical attachment level . Two studies used tooth loss as the primary outcome, while Saxlin et al .…”

“…A cross‐sectional study conducted by Meisel et al . , aiming to evaluate the influence of statins on periodontal parameters, included subjects older than 30 years and excluded the toothless. They identified 219 subjects who used statins and 2937 who did not use the drug.…”

Evaluation of anti-inflammatory effect of statins in chronic periodontitis

“…[17] The administration of statins to cardiovascular patients may have additional benefits through inhibition of inflammation in oral tissues. Meisel et al .,[18] described statins as effect modifiers in the relationship between periodontitis and its inflammatory counterparts in the systemic circulation. Statins could attenuate the inflammation-related systemic effects.…”

Effect of topical simvastatin (1.2mg) on gingival crevicular fluid interleukin-6, interleukin-8 and interleukin-10 levels in chronic periodontitis – A clinicobiochemical study

“…SMV also influences production of inflammatory cytokines via Creactive protein. 7 We restricted the present study to three cytokines, which are strongly associated with periodontal inflammation namely IL-6, IL-8 and IL-10. IL-6: Associated with terminal differentiation of B-lymphocytes (plasma cell) and activation of complement cascade.…”