The aim of this retrospective study was to investigate possible associations between clinically classified periodontitis as determined by assessing its severity and diagnosed coronary heart disease in outpatients referred to a specialist clinic for neurosurgery treatment. A total of 2,912 individuals were clinically examined for periodontal disease experience by using probing pocket depth (PPD) and clinical attachment loss (CAL). Socioeconomic, oral health behaviour, and general health related information was collected by using a self-administered questionnaire. Statistical analysis of the questionnaire items was performed by using multivariate logistic regression analysis model. The results showed that the occurrence of hypertension ( , 95% CI？=？1.52–3.84), smoking ( , 95% CI？=？1.25–3.11), classified periodontitis ( , 95% CI？=？1.15–2.77), and the high level of serum C-reactive protein ( , 95% CI？=？1.05–2.89) were significantly associated with the presence of coronary heart disease. These observations strengthen the role of some of the traditional causative risk factors for coronary heart disease while a significant association was recorded between diagnosed coronary heart disease and clinically classified periodontitis which is considered as a risk factor for coronary heart disease. 1. Introduction Cardiovascular diseases (CVD) and in particular coronary heart disease (CHD) represent a severe health condition and the main cause of mortality nowadays in industrialized societies. CHD is a multifactorial pathological condition and occurs as a result of genetic, environmental, and behavioral risk factors [1] while chronic inflammation has been implicated etiologically in CVD and CHD [2]. The genetic factors include age, gender, hypertension, diabetes mellitus, marked obesity, lipid metabolism, fibrinogen levels, and platelet P1 polymorphism [3–5]. The environmental and behavioral risk factors include diet, physical inactivity, stress, cigarette smoking, excessive alcohol consumption, socioeconomic status, chronic infections, use of nonsteroid anti-inflammatory drugs, and possible endothelial cell injury [4–7]. However, a significant proportion of CHD is not explained by the traditional risk factors [8]. Periodontitis is a complex chronic inflammatory disease, resulting in a loss of connective tissue and bone support of the teeth [9]. Previous studies have linked several risk factors to periodontitis including diabetes mellitus, smoking, age, gender, low socioeconomic status [10], dyslipidemias, and excessive alcohol consumption [9, 11], whereas the genetic
References
[1]
R. A. Hegele, “The pathogenesis of atherosclerosis,” Clinica Chimica Acta, vol. 246, no. 1-2, pp. 21–38, 1996.
[2]
P. M. Ridker, M. Cushman, M. J. Stampfer, R. P. Tracy, and C. H. Hennekens, “Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men,” The New England Journal of Medicine, vol. 336, no. 14, pp. 973–979, 1997.
[3]
P. M. Ridker, C. H. Hennekens, J. E. Buring, and N. Rifai, “C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women,” The New England Journal of Medicine, vol. 342, no. 12, pp. 836–843, 2000.
[4]
F. A. Scannapieco, R. B. Bush, and S. Paju, “Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A systematic review,” Annals of Periodontology, vol. 8, no. 1, pp. 38–53, 2003.
[5]
V. Keil, “Coronary artery disease: the role of lipids, hypertension and smoking,” Basic Research in Cardiology, vol. 95, supplement 1, pp. 152–158, 2000.
[6]
E. J. Weiss, P. F. Bray, M. Tayback et al., “A polymorphism of a platelet glycoprotein receptor as an inherited risk factor for coronary thrombosis,” The New England Journal of Medicine, vol. 334, no. 17, pp. 1090–1094, 1996.
[7]
L. M. Buja, “Does atherosclerosis have an infectious etiology?” Circulation, vol. 94, no. 5, pp. 872–873, 1996.
[8]
C. Cabrera, M. Hakeberg, M. Ahlqwist et al., “Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the Population Study of Women in Gothenburg, Sweden,” European Journal of Epidemiology, vol. 20, no. 3, pp. 229–236, 2005.
[9]
N. Y. Karimbux, V. M. Saraiya, S. Elangovan, et al., “Interleukin-1 gene polymorphisms and chronic periodontitis in adult whites: a systematic review and meta-analysis,” Journal of Periodontology, vol. 83, pp. 1407–1419, 2012.
[10]
L. L. Humphrey, R. Fu, D. I. Buckley, M. Freeman, and M. Helfand, “Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis,” Journal of General Internal Medicine, vol. 23, no. 12, pp. 2079–2086, 2008.
[11]
R. J. Genco, “Current view of risk factors for periodontal diseases,” Journal of Periodontology, vol. 67, supplement 10, pp. 1041–1049, 1996.
[12]
A. Stabholz, W. A. Soskolne, and L. Shapira, “Genetic and environmental risk factors for chronic periodontitis and aggressive periodontitis,” Periodontology 2000, vol. 53, no. 1, pp. 138–153, 2010.
[13]
A. S. Schaefer, G. M. Richter, B. Groessner-Schreiber et al., “Identification of a shared genetic susceptibility locus for coronary heart disease and periodontitis,” PLoS Genetics, vol. 5, no. 2, Article ID e1000378, 2009.
[14]
J. Katz, M. Y. Flugelman, A. Goldberg, and M. Heft, “Association between periodontal pockets and elevated cholesterol and low density lipoprotein cholesterol levels,” Journal of Periodontology, vol. 73, no. 5, pp. 494–500, 2002.
[15]
T. Wu, M. Trevisan, R. J. Genco, K. L. Falkner, J. P. Dorn, and C. T. Sempos, “Examination of the relation between periodontal health status and cardiovascular risk factors: serum total and high density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen,” American Journal of Epidemiology, vol. 151, no. 3, pp. 273–282, 2000.
[16]
T. G. Shrihari, “Potential correlation between periodontitis and coronary heart disease-An overview,” General Dentistry, vol. 60, no. 1, pp. 20–24, 2012.
[17]
K. Tang, M. Lin, Y. Wu, and F. Yan, “Alterations of serum lipid and inflammatory cytokine profiles in patients with coronary heart disease and chronic periodontitis: a pilot study,” Journal of International Medical Research, vol. 39, no. 1, pp. 238–248, 2011.
[18]
C. Starkhammar-Johansson, A. Richter, ？. Lundstr？m, H. Thorstensson, and N. Ravald, “Periodontal conditions in patients with coronary heart disease: a case-control study,” Journal of Clinical Periodontology, vol. 35, no. 3, pp. 199–205, 2008.
[19]
K. Joshipura, J. C. Zevallos, and C. S. Ritchie, “Strength of evidence relating periodontal disease and atherosclerotic disease,” Compendium of Continuing Education in Dentistry, vol. 30, no. 7, pp. 430–439, 2009.
[20]
A. Blaizot, J.-N. Vergnes, S. Nuwwareh, J. Amar, and M. Sixou, “Periodontal diseases and cardiovascular events: metaanalysis of observational studies,” International Dental Journal, vol. 59, no. 4, pp. 197–209, 2009.
[21]
A. Pejcic, L. Kesic, Z. Brkic, Z. Pesic, and D. Mirkovic, “Effect of periodontal treatment on lipoproteins levels in plasma in patients with periodontitis,” Southern Medical Journal, vol. 104, no. 8, pp. 547–552, 2011.
[22]
V. E. Friedewald, K. S. Kornman, J. D. Beck et al., “The American journal of cardiology and journal of periodontology editors consensus: eriodontitis and atherosclerotic cardiovascular disease,” Journal of Periodontology, vol. 80, no. 7, pp. 1021–1032, 2009.
[23]
M. E. Sanz, J. C. López, and J. L. Alonso, “Six conformers of neutral aspartic acid identified in the gas phase,” Physical Chemistry Chemical Physics, vol. 12, no. 14, pp. 3573–3578, 2010.
[24]
M. Latronico, A. Segantini, F. Cavallini et al., “Periodontal disease and coronary heart disease: an epidemiological and microbiological study,” New Microbiologica, vol. 30, no. 3, pp. 221–228, 2007.
[25]
A. A. Bahekar, S. Singh, S. Saha, J. Molnar, and R. Arora, “The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: a meta-analysis,” American Heart Journal, vol. 154, no. 5, pp. 830–837, 2007.
[26]
H.-C. Hung, G. Colditz, and K. J. Joshipura, “The association between tooth loss and the self-reported intake of selected CVD-related nutrients and foods among US women,” Community Dentistry and Oral Epidemiology, vol. 33, no. 3, pp. 167–173, 2005.
[27]
J. Liu, Y. Wu, Y. Ding, S. Meng, S. Ge, and H. Deng, “Evaluation of serum levels of C-reactive protein and lipid profiles in patients with chronic periodontitis and/or coronary heart disease in an ethnic Han population,” Quintessence International, vol. 41, no. 3, pp. 239–247, 2010.
[28]
D. Matthews, “Possible link between periodontal disease and coronary heart disease,” Evidence-Based Dentistry, vol. 9, no. 1, p. 8, 2008.
[29]
A. M. Monteiro, M. A. N. Jardini, S. Alves et al., “Cardiovascular disease parameters in periodontitis,” Journal of Periodontology, vol. 80, no. 3, pp. 378–388, 2009.
[30]
S. Ge, Y. F. Wu, T. J. Liu, S. Meng, and L. Zhao, “Study of the correlation between moderately and severely chronic periodontitis and coronary heart disease,” Hua Xi Kou Qiang Yi Xue Za Zhi, vol. 26, no. 3, pp. 262–266, 2008.
[31]
S. O. Geerts, V. Legrand, J. Charpentier, A. Alberts, and E. H. Rompen, “Further evidence of the association between periodontal conditions and coronary artery disease,” Journal of Periodontology, vol. 75, no. 9, pp. 1274–1280, 2004.
[32]
S. E. Asikainen, “Periodontal bacteria and cardiovascular problems,” Future Microbiology, vol. 4, no. 5, pp. 495–498, 2009.
[33]
K. J. Beck, R. Garcia, G. Heiss, P. S. Vokonas, and S. Offenbacher, “Periodontal disease and cardiovascular disease,” Journal of Periodontology, vol. 67, no. 10, pp. 1123–1137, 1996.
[34]
S. Renvert, C. Lindahl, A.-M. Roos-Jans？ker, and J. Lessemi, “Short-term effects of an anti-inflammatory treatment on clinical parameters and serum levels of c-reactive protein and proinflammatory cytokines in subjects with periodontitis,” Journal of Periodontology, vol. 80, no. 6, pp. 892–900, 2009.
[35]
P. P. Hujoel, M. Drangsholt, C. Spiekerman, and T. A. DeRouen, “Periodontal disease and coronary heart disease risk,” Journal of the American Medical Association, vol. 284, no. 11, pp. 1406–1410, 2000.
[36]
A. D. Haffajee and S. S. Socransky, “Relationship of cigarette smoking to attachment level profiles,” Journal of Clinical Periodontology, vol. 28, no. 4, pp. 257–265, 2001.
[37]
P. V. Ylostalo and M. L. Knuutila, “Confounding and effect modification; possible explanation for variation in the results on the association between oral and systemic diseases,” Journal of Clinical Periodontology, vol. 33, pp. 104–108, 2006.
[38]
I.-C. Kang and H. K. Kuramitsu, “Induction of monocyte chemoattractant protein-1 by Porphyromonas gingivalis in human endothelial cells,” FEMS Immunology and Medical Microbiology, vol. 34, no. 4, pp. 311–317, 2002.
[39]
I. Glurich, S. Grossi, B. Albini et al., “Systemic inflammation in cardiovascular and periodontal disease: comparative study,” Clinical and Diagnostic Laboratory Immunology, vol. 9, no. 2, pp. 425–432, 2002.
[40]
B. G. Loos, J. Craandijk, F. J. Hoek, P. M. E. Wertheim-van Dillen, and U. van der Velden, “Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients,” Journal of Periodontology, vol. 71, no. 10, pp. 1528–1534, 2000.
[41]
K. S. Kornman and G. W. Duff, “Candidate genes as potential links between periodontal and cardiovascular diseases,” Annals of Periodontology, vol. 6, no. 1, pp. 48–57, 2001.
[42]
I. J. Kullo and K. Ding, “Mechanisms of disease: the genetic basis of coronary heart disease,” Nature Clinical Practice Cardiovascular Medicine, vol. 4, no. 10, pp. 558–569, 2007.
[43]
R. Tuominen, A. Reunanen, M. Paunio, I. Paunio, and A. Aromaa, “Oral health indicators poorly predict coronary heart disease deaths,” Journal of Dental Research, vol. 82, no. 9, pp. 713–718, 2003.
[44]
J. W. Little, “Periodontal disease and heart disease: are they related?” General Dentistry, vol. 56, no. 7, pp. 733–737, 2008.
[45]
U. Stenman, A. Wennstr？m, M. Ahlqwist et al., “Association between periodontal disease and ischemic heart disease among Swedish women. A cross-sectional study,” Acta Odontologica Scandinavica, vol. 67, no. 4, pp. 193–199, 2009.
[46]
A. Holmlund, G. Holm, and L. Lind, “Number of teeth as a predictor of cardiovascular mortality in a cohort of 7,674 subjects followed for 12 years,” Journal of Periodontology, vol. 81, no. 6, pp. 870–876, 2010.
[47]
P. P. Hujoel, M. Drangsholt, C. Spiekerman, and T. A. Derouen, “Examining the link between coronary heart disease and the elimination of chronic dental infections,” The Journal of the American Dental Association, vol. 132, no. 7, pp. 883–889, 2001.
[48]
S. A. H. Bokhari and A. A. Khan, “The relationship of periodontal disease to cardiovascular diseases—review of literature,” Journal of the Pakistan Medical Association, vol. 56, no. 4, pp. 177–181, 2006.
[49]
P. N. Papapanou, “Periodontal diseases: epidemiology,” Annals of Periodontology, vol. 1, no. 1, pp. 1–36, 1996.
[50]
R. Genco, S. Offenbacher, and J. Beck, “Periodontal disease and cardiovascular disease: epidemiology and possible mechanisms,” The Journal of the American Dental Association, vol. 133, supplement, pp. 14S–22S, 2002.
[51]
E. N. Deliargyris, I. Marron, W. Kadoma et al., “Periodontal disease and acute myocardial infarction,” Circulation, vol. 102, supplement 2, p. 710, 2004.
[52]
G. Machuca, J. J. Segura-Egea, G. Jiménez-Beato, J. R. Lacalle, and P. Bullón, “Clinical indicators of periodontal disease in patients with coronary heart disease: a 10 years longitudinal study,” Medicina Oral, Patologia Oral, Cirugia Bucal, vol. 17, no. 4, pp. e569–e574, 2012.
[53]
S. C. Smith Jr., S. N. Blair, R. O. Bonow et al., “AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: a statement for healthcare professionals from the american heart association and the american college of cardiology,” Circulation, vol. 104, no. 13, pp. 1577–1579, 2001.
[54]
R. C. Page and P. I. Eke, “Case definitions for use in population-based surveillance of periodontitis,” Journal of Periodontology, vol. 78, no. 7, supplement, pp. 1387–1399, 2007.
[55]
M. Desvarieux, R. T. Demmer, T. Rundek et al., “Relationship between periodontal disease, tooth loss, and carotid artery plaque: the oral infections and vascular disease epidemiology study (INVEST),” Stroke, vol. 34, no. 9, pp. 2120–2125, 2003.
[56]
S. Amar, N. Gokce, S. Morgan, M. Loukideli, T. E. Van Dyke, and J. A. Vita, “Periodontal disease is associated with brachial artery endothelial dysfunction and systemic inflammation,” Arteriosclerosis, Thrombosis, and Vascular Biology, vol. 23, no. 7, pp. 1245–1249, 2003.
[57]
J. R. Elter, S. Offenbacher, J. F. Toole, and J. D. Beck, “Relationship of periodontal disease and edentulism to stroke/TIA,” Journal of Dental Research, vol. 82, no. 12, pp. 998–1001, 2003.
[58]
R. A. Seymour, P. M. Preshaw, J. M. Thomason, J. S. Ellis, and J. G. Steele, “Cardiovascular diseases and periodontology,” Journal of Clinical Periodontology, vol. 30, no. 4, pp. 279–292, 2003.
