Oral Health & Cardiovascular disease

Periodontitis and Cardiovascular Disease: A Consensus

In recent years, the link between periodontitis and cardiovascular disease (CVD) has been investigated by several research groups. For example, one meta-analysis showed an increased prevalence of coronary artery disease in patients with periodontitis, and another revealed that periodontitis is a risk factor for cerebrovascular disease (an analysis of the National Health and Nutrition Examination Survey and its Epidemiologic Follow-up Study).1 In addition, subclinical atherosclerosis (an underlying cause of CVD), evidenced by increased carotid artery wall thickness, has often been reported in patients with periodontitis.1 Although these studies suggest that patients with a history of periodontal disease have a higher risk for CVD, no clear evidence of a causative role between the two conditions has been demonstrated. Despite this, the relationship between periodontitis and CVD is important enough that an editors’ consensus report was published simultaneously in the Journal of Periodontology2 and the American Journal of Cardiology.1 Clinical recommendations to cardiologists and periodontists were reported that aim to reduce the potential risk of a cardiovascular event for patients with periodontitis, and to optimize periodontal care for patients with CVD. The consensus report addresses a wide spectrum of scenarios, summarized in the table; the panel’s confidence (rated from 1 to 4) and the strength of scientific evidence (rated from A to D) of each recommendation was given. It recommends various interventions, ranging from referral to clinical evaluation to lifestyle change, and/or pharmacologic therapy. Possible Mechanisms for the Association between Periodontitis and Cardiovascular Disease Inflammation is believed to be an integrative factor related to both periodontitis and atherosclerotic CVD.1 Periodontitis is a bacterially induced chronic inflammatory disease; its progression depends on environmental, genetic, and acquired risk factors. Moderate to severe forms of periodontitis are associated with increased systemic inflammation. In CVD, inflammation is involved from the very early stages of atherosclerosis (development of atherosclerotic plaque), and continues to play a role in cardiovascular complications. It was previously shown that elevated levels of an inflammatory biomarker, high-sensitivity C-reactive protein (hs-CRP), is an independent predictor of acute myocardial infarction (AMI).1 Consequently, the incidence of cardiovascular events is increased in the presence of chronic inflammatory conditions, including periodontitis.1 Moreover, bacterial infection may be another direct link between periodontal and cardiovascular diseases; the same species of gram-negative anaerobic bacteria are found in periodontal pockets and in atherosclerotic plaques.1 These include smoking, diabetes, obesity, dyslipidemia, hypertension, major depression, physical inactivity, older age, male gender, and family history of disease.

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References 1. Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, et al. The American Journal of Cardiology and Journal of Periodontology editors’ consensus: Periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol 2009;104(1):59-68. 2. Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, et al. The American Journal of Cardiology and Journal of Periodontology editors’ consensus: Periodontitis and atherosclerotic cardiovascular disease. J Periodontol 2009;80(7):1021-1032. 3. Kornman KS. Editorial: A call to action. J Periodontol 2009;80(7):1019-1020.
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