The Infection Hypothesis Revisited: Oral Infection and Cardiovascular Disease

Abstract

Background.The pathophysiology of cardiovascular disease (CVD) includes inflammation in the development of atherosclerosis and thrombosis. Increasing evidence supports oral infections, and in particular the common periodontal disease, to be associated with CVD development. Periodontal infection is present in populations worldwide and in the moderate to mild form in about 35% of populations according to the World Health Organization.Objective.This review of the literature aims to present cross evidence from medical research disciplines that explore how oral infections can contribute to increase the risk for CVDs and how treatment of oral infections can reduce the risk for CVDs.Design.Review article.Results.Long-term exposure to active nontreated infections of the oral cavity presents an opportunity for bacteria, bacterial products, and viruses to enter the circulation. Toxic bacterial products enter the circulation, affecting atherosclerosis, causing platelet adhesiveness that results in clot formation, and establishing cardiac vegetation. Pathological observations have identified oral bacteria in heart valves, aortic aneurysms, and arterial walls. Clinical intervention studies on periodontal disease reduce the risk level of serological predictors for CVDs.Conclusions.This paper presents evidence across medical research disciplines for oral infections to be considered as one of the risk factors for CVDs.

Oral health and cardiovascular disease risk factors and mortality of cerebral haemorrhage, cerebral infarction and unspecified stroke in elderly men: A prospective cohort study

“…Hs-C-reactive protein was analysed from frozen serum for 5323 participants and the number of participants is reduced in the multivariate analyses compared to univariate analyses. These factors are known to be potential confounders for the different stroke diagnoses as they are for myocardial infarction and CVD overall [1].…”

“…The association between oral health and stroke has been studied using different approaches [1]. Oral health is diagnosed clinically by a partial or full mouth examination.…”

Age and Age-Related Diseases: Role of Inflammation Triggers and Cytokines

“…The gut microbiome has been implicated in age-related inflammation ( 354 ) with numerous studies reporting bacterial organisms in arterial plaque ( 355 – 357 ). Emerging research reports bacterial DNA in blood associated with a personal microbiota fingerprint as a predictor of cardiovascular events and stool microbiome as a signature of cardiovascular disease ( 358 , 359 ).…”

Analysis of the blood bacterial composition of patients with acute coronary syndrome and chronic coronary syndrome

“…Several studies have documented an association between chronic infections and the risk of cardiovascular disease ( Armingohar et al., 2014 ; Lund Håheim, 2014 ; Lawrence et al., 2022 ). The circulation is a closed system, and the blood in healthy individuals was earlier believed to represent a sterile environment, which is the basis for safe blood transfusions ( Damgaard et al., 2015 ).…”

“…Atherosclerosis is well known as a low-grade, chronic inflammation of the arterial wall, and is an important factor in the development of several diagnoses of cardiovascular disease. For many years bacteria have been suspected to be part of the pathogenesis of this group of diseases, as whole bacteria, fragments, and their DNA have been identified in blood from cardiovascular disease patients ( Koren et al., 2011 ; Amar et al., 2013 ; Armingohar et al., 2014 ; Dinakaran et al., 2014 ; Lund Håheim, 2014 ). Several other key processes may be responsible for atherosclerosis; among them accumulation of monocyte/macrophage lineage cells within the lipid-rich subendothelial space of the affected artery where bacterial lipopolysaccharide (LPS) also participates in the formation of macrophage-derived foam cells ( Tabas and Lichtman, 2017 ; An et al., 2018 ).…”