Arterial stiffness in periodontitis patients and controls

Abstract

Increased arterial stiffness (AS) is an important indicator for atherosclerotic cardiovascular disease (ACVD). Epidemiologically, periodontitis and ACVD are associated. Therefore, we aimed to investigate AS in periodontitis patients and controls. In addition, we explored the effect of periodontal therapy on AS in a sub-group of cases. Pulse-wave velocity (PWV), a non-invasive chair-side function test for AS, was measured in periodontitis patients (n=57; mean age 46.6 years) and compared with a reference group (n=48; mean age 45.5 years). In addition, 45 cases (mean age 46.9 years) were 6 months followed after periodontal treatment, to explore a possible effect on arterial function. Periodontitis patients showed a significantly increased PWV compared with the reference group (8.01±0.20 vs. 7.36±0.22 m s(-1) respectively; P=0.029) and this remained significant after adjustments for ACVD risk factors (P=0.019). After periodontal therapy, no significant reduction in PWV was seen (8.00±1.8 to 7.82±1.6 m s(-1); P=0.13), but systolic blood pressure (SBP) was significantly reduced (119.8±14.6 to 116.9±15.1 mm Hg; P=0.040). It can be concluded that periodontitis is associated with increased AS. This confirms with a new parameter the association of periodontitis with ACVD. Although periodontal treatment did not lower AS significantly, a modest reduction of SBP after 6 months was observed.

Comorbidity of periodontal disease: two sides of the same coin? An introduction for the clinician

“…Spillover of such cytokines and cytokine producing cells to the bloodstream may enhance inflammation in the atherosclerotic arterial walls and result in unstable plaques. Thus, elevated levels of some proinflammatory cytokines, including interleukin (IL)-6 and tumor necrosis factor alpha, have been found in the bloodstream of patients with PDIS, and PDIS may thus cause systemic low-grade inflammation [18–21] promoting, for example, endothelial dysfunction and development of insulin resistance. Systemic production of cytokines Increased plasma level of cytokines in response to bacteremia after oral procedures is a well-described phenomenon. For example, increased IL-6 levels were found in the bloodstream as a result of bacteremia after scaling [22], and this cytokine is a known risk marker for CVD, including AMI [23,24].…”

Impact of anti‐infective periodontal therapy on parameters of vascular health

“…The Australian study (Kapellas, Maple‐Brown, et al., ) and the trial by Houcken et al. (Houcken et al., ) by contrast were unable to verify any significant effect on PWV. The most obvious explanation for these differences may be attributed to differences in the severity of the periodontal conditions and the study protocols.…”

“…Despite different selection criteria, however, all four trials and several other observational studies (Franek et al., ; Hayashida et al., ; Houcken et al., ; Kapellas, Jamieson, et al., ; Kapellas, Maple‐Brown, et al., ; Miyaki et al., ; Vieira et al., ) consistently reported elevated PWV values at baseline. Nevertheless, besides the present study, only the pilot project by Vidal et al.…”

“…Few studies so far investigated the specific relation between PWV and periodontal therapy: there are two pilot projects (Houcken et al., ; Vidal, Cordovil, Figueredo, & Fischer, ), one short time trial (Ren et al., ) and a larger scale study involving Australian aborigines (Kapellas, Maple‐Brown, et al., ). The pilot study (Vidal et al., ) was performed in 26 hypertensive patients.…”

“…Houcken et al. () only included patients with unimpaired general health, while Vidal et al. () selectively included hypertensive patients.…”