Periodontal Disease Is Associated with Increased Vulnerability of Coronary Atheromatous Plaques in Patients Undergoing Coronary Computed Tomography Angiography—Results from the Atherodent Study

Abstract

The present study aimed to investigate the link between the severity of periodontal disease (PD), coronary calcifications and unstable plaque features in patients who underwent coronary computed tomography for unstable angina (UA). Fifty-two patients with UA, included in the ATHERODENT trial (NCT03395041), underwent computed tomographic coronary angiography (CCTA) and dental examination. Based on the median value of the periodontal index (PI), patients were assigned to the low periodontal index (LPI) group (PI < 22) and a high periodontal index (HPI) group (PI > 22). Patients with HPI had higher plaque volume (p = 0.013) and noncalcified plaque volume (p = 0.0003) at CCTA. In addition, the presence of vulnerability features in the atheromatous plaques was significantly correlated with PI (p = 0.001). Among periodontal indices, loss of gingival attachment (p = 0.009) and papillary bleeding index (p = 0.002) were strongly associated with high-risk plaques. PI significantly correlated with coronary calcium score (r = 0.45, p = 0.0008), but not with traditional markers of subclinical atherosclerosis. Overall, this subgroup analysis of the ATHERODENT study indicates that patients with advanced PD and UA present a higher amount of calcium in the coronary tree and have a more vulnerable phenotype of their culprit plaques.

The Influence of Periodontal Disease on Oral Health Quality of Life in Patients with Cardiovascular Disease: A Cross-Sectional Observational Single-Center Study

“…The oral-health-related quality of life in patients with chronic diseases is a current discussion topic [ 65 ] including patients with cardiovascular disease and a relationship between periodontal and cardiovascular disease has been assessed in several studies [ 66 , 67 ].…”

Is There a Link between COVID-19 Infection, Periodontal Disease and Acute Myocardial Infarction?

“…Similar results were obtained by Gomes-Filho et al (2020), who proved that the PD severity is strongly associated with the risk of developing an ACS (two to four times higher risk) [20]. Similar results were obtained in the ATHERODENT trial, an Angio-CT based study that investigated the correlation between PD and CT features of vulnerable atheromatous plaques, and revealed a direct link between PD severity, atherosclerosis and coronary plaque vulnerability in patients with unstable angina (UA) [ (21]. Thus, it was observed that in patients with high-risk plaques (that contain at least two of the following vulnerability features: napkin ring, spotty calcification, low attenuation atheroma and positive remodeling), the PD was more severe compared with those without VP (28.20 ± 13.34 vs. 18.71 ± 11.31, p = 0.001).…”

“…Moreover, a higher calcium score was identified in patients with PD, especially in those with severe forms (p = 0.0001). The gingival indices most frequently associated with ACS in the ATHERO-DENT trial were papillary bleeding index (4.5 ± 3.06 vs. 2.04 ± 1.96, p = 0.002) and clinical attachment loss, an irreversible sign of PD (3.6 ± 2.91 vs. 1.66 ± 1.8, p = 0.009) [21].…”

Unexpected Relationships: Periodontal Diseases: Atherosclerosis–Plaque Destabilization? From the Teeth to a Coronary Event

“…The risk of carotid artery calcification was significantly higher by 102% in patients with PD (OR = 2.02; 95% CI: 1.18–3.45) [ 104 ]. It is also worth mentioning that the study by Rodean et al showed that the occurrence of PD was associated with a higher risk of the presence of high-risk atherosclerotic plaques in the coronary arteries [ 105 ]. In a study by Cowan et al including 8092 participants who were followed for an average of 12.9 years, PD was shown to independently increase the risk of venous thromboembolism by 29% (HR = 1.65; 95% CI: 1.25–2.18), with this association it weakened because confounding factors were taken into account [ 106 ].…”