Can Periodontitis Influence the Progression of Abdominal Aortic Aneurysm? A Systematic Review

Abstract

There is some evidence that periodontitis increases the risk of atherothrombosis. Abdominal aortic aneurysm (AAA) is a cardiovascular disease with specific risk factors and physiopathological mechanisms that can lead to rupture in the absence of treatment. The aim of the present systematic review was to explore the influence of periodontitis on the progression of AAAs as a specific disease. A systematic search in PubMed/MEDLINE and Embase databases was performed. Human and animal studies exploring the influence of periodontal pathogens on the progression of AAA were considered for inclusion. After systematic screening, 5 articles were included in the review. Due to the heterogeneity of the selected studies, a metaanalysis could not be performed. The descriptive analyses of the studies emphasized that periodontal pathogens or their by-products contribute to systemic and local innate immunity likely to be associated with AAA physiopathology. Periodontitis seems to play a role in the development and progression of AAA. The present systematic review suggests that the presence of periodontal bacteria in the bloodstream or in situ in the vascular lesion is a risk associated with aneurysmal disease progression.

Further evidence on the relationship between abdominal aortic aneurysm and periodontitis: A cross‐sectional study

“…17,18,20 A recent systematic review highlighted that Pg might be responsible for destructive proteolytic activity, oxidative stress, and cytokines activation, leading to the inflammation of the abdominal aortic wall and hence inducing the loss of the dynamic capacity of the vessel and its increase in size. 23 Moreover, Pg was also correlated with the ILT increase T specific to AAA progression. In our study, a statistical tendency was found between the presence of Pg and ILT enhancement, but recently some authors 26 demonstrated that Pg invasion of ILT promotes the formation of neutrophils on the interface between the thrombus and blood circulation.…”

“…However, Pg pathogens are able to attach and invade host cells, such as red blood cells, through hemagglutinin and fimbriae, 47 and can also induce metastatic infection at “locus minoris resistentiae” 17,18,20 . A recent systematic review highlighted that Pg might be responsible for destructive proteolytic activity, oxidative stress, and cytokines activation, leading to the inflammation of the abdominal aortic wall and hence inducing the loss of the dynamic capacity of the vessel and its increase in size 23 . Moreover, Pg was also correlated with the ILT increase T specific to AAA progression.…”

“…Nevertheless, a recent systematic review reported that the presence of periodontal bacteria in the bloodstream or in situ in the vascular lesion is a risk factor associated with AAA progression. 23 Several animal studies have also emphasized the role of periopathogens such as Porphyromonas gingivalis (Pg) in AAA dilation through local inflammatory destruction in both the aortic wall and ILT. [24][25][26] Other clinical studies emphasized the presence of periodontal pathogens in aneurysmal samples, [26][27][28] Pg antibodies in the plasma, and a positive correlation between the AAA diameter and the thrombus.…”

“…However, AAA is considered as a specific cardiovascular disease in which inflammation and the presence of an ILT play a key role in its physiopathogenesis 22 and the prevalence of periodontitis in patients presenting this specific form of CVD is not available in the literature. Nevertheless, a recent systematic review reported that the presence of periodontal bacteria in the bloodstream or in situ in the vascular lesion is a risk factor associated with AAA progression 23 . Several animal studies have also emphasized the role of periopathogens such as Porphyromonas gingivalis ( Pg ) in AAA dilation through local inflammatory destruction in both the aortic wall and ILT 24‒26 .…”

The Role of Porphyromonas gingivalis Outer Membrane Vesicles in Periodontal Disease and Related Systemic Diseases

“…Results of Zaremba et al support the possibility that bacteria associated with periodontitis can permeate into coronary vessels as well (Zaremba et al, 2007). Current research shows that the presence of periodontal bacteria in the bloodstream or in situ in the vascular lesions is a risk associated with the development of aneurysmal disease (Salhi et al, 2019), and the main feature of P. gingivalis infection associated with aneurysms is the proliferation of smooth muscle cells in the distal aorta (Wada and Kamisaki, 2010). It has been found that P. gingivalis can be detected in atherosclerotic plaque (Figuero et al, 2011;Szulc et al, 2015), and observed the significance of P. gingivalis type II FimA for atherosclerosis (Mahalakshmi et al, 2017).…”