Comparing serum levels of cardiac biomarkers in cancer patients receiving chemotherapy and subjects with chronic periodontitis

Abstract

BackgroundChronic periodontitis (CP) is a chronic inflammation associated with elevations of several inflammatory and cardiac markers. Studies implicated CP as one of the etiologies in coronary heart disease (CHD). Cardiotoxicity is a major complication of anticancer drugs, including anthracyclines and 5-fluorouracil (5FU). The most severe cardiac complications are heart failure, arrhythmia and coronary heart disease (CHD). In this study, we compared the level of inflammatory factors and cardiac markers between chronic periodontitis patients and cancer patients receiving chemotherapy.Methods108 blood samples of periodontally healthy subjects were obtained on random from Hong Kong Red Cross, and these represented the controlled population. Forty-four patients diagnosed with chronic periodontitis were recruited from the West China Hospital of Stomatology, Sichuan University. They have received scaling and root planning with mean pocket depths of 6.05 mm. Thirty breast cancer patients diagnosed with invasive ductal carcinoma from UNIMED Medical Institute, Hong Kong gave consent to participate in this study. They received 4 cycles of 500mg/m2 5-fluorouracil, 75 mg/m2 epirubicin and 500mg/m2 cyclophosphamide at a 3-week interval between each cycle. Peripheral venous blood from each group was taken for measurement of blood cells, inflammatory marker (P-selectin, high sensitvity C-reactive protein) and cardiac markers (troponin T; troponin I; N-terminal pro brain natriuretic peptide (Nt-proBNP) and Lactate dehydrogenase (LDH).ResultsThe lymphocyte count was higher (p < 0.05) in periodontitis patients than the other two groups, and more neutrophils (p < 0.05) were seen in cancer patients receiving chemotherapy. The two test groups demonstrated higher levels (p < 0.01) of inflammatory and cardiac markers than the control group.ConclusionsThe elevated cardiac markers found in periodontitis patients suggested that they may carry potential risks in developing cardiac lesions. Troponin T, troponin I, pro-BNP, LDH and high sensitvity C-reactive protein may be used as markers to monitor cardiac lesions in chronic inflammatory patients.

Associations between tooth loss and prognostic biomarkers and the risk for cardiovascular events in patients with stable coronary heart disease

“…An independent association with cardiac biomarkers could support a more specific link between tooth loss, its antecedents, and cardiac pathology. This was previously investigated in a small study where 44 patients with clinical evidence of PD had higher levels of troponin and NT-proBNP compared to controls, however these associations were unadjusted [27]. The association with NT-proBNP in our study suggests a relationship between tooth loss and baseline cardiac dysfunction that persisted after adjustment for traditional important heart failure determinants, including prior MI, hypertension and diabetes.…”

“…All biomarkers were analyzed on a log-transformed scale using linear models. Geometric mean ratios are presented with 95% confidence intervals (CI) with the lowest tooth loss level (26)(27)(28)(29)(30)(31)(32) replacing significant renal dysfunction) [16], hemoglobin, white blood cells, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides. Cox proportional hazards models were used to calculate hazard ratios for MACE, CV death and stroke in relation to tooth loss levels, adjusting for biomarkers in addition to a previously reported multivariable model [4], co-variables of which are also listed in Table 3.…”

Protective effect of alpha‐lipoic acid against apical periodontitis‐induced cardiac injury in rats

“…The activities of CK, LDH, and ALP in serum are widely used as markers of inflammation for the diagnosis of the cardiac injury. In addition, CK, LDH, and ALP activities in the systemic circulation reflect ongoing inflammation and/or tissue damage . A significant increase of enzyme activities in serum has emerged as the biochemical response to AP‐induced cardiac damage .…”

“…Previous animal studies on rats have demonstrated that AP affects blood homeostasis; it increases the serum levels of inflammatory mediators and thus can affect systemic health . Alterations in expression of inflammatory markers, such as creatine kinase (CK), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH), and in the activities of antioxidant enzymes, such as superoxide dismutase (SOD), have previously been studied in cardiovascular diseases and marginal periodontitis . However, so far, very little attention has been paid to their role in AP.…”

Role of Cytokines and Transcription Factors in Periodontitis: A Review of Cellular and Molecular Mechanisms

“…In this context, the increase in the number of White Blood Cells (WBC) is associated with the increased risk of coronary heart disease, CVD, atherosclerosis, thrombosis and myocardial ischemia. This increase may be caused by the inflammatory nature of chronic infections, such as, periodontitis (Loo et al, 2012).…”