Inflammation of the periodontium associates with risk of future cardiovascular events

Abstract

Background: While growing evidence suggests a link between periodontal disease (PD) and cardiovascular disease (CVD), the independence of this association and the pathway remain unclear. Herein, we tested the hypotheses that: (1) inflammation of the periodontium (PD inflammation) predicts future CVD independently of disease risk factors shared between CVD and PD, and (2) the mechanism linking the two diseases involves heightened arterial inflammation. Methods: 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG-PET/CT) imaging was performed in 304 individuals (median age 54 years; 42.4% male) largely for cancer screening; individuals without active cancer were included. PD inflammation and arterial inflammation were quantified using validated 18 F-FDG-PET/CT methods. Additionally, we evaluated the relationship between PD inflammation and subsequent major adverse cardiovascular events (MACE) using Cox models and log-rank tests. Results: Thirteen individuals developed MACE during follow-up (median 4.1 years). PD inflammation associated with arterial inflammation, remaining significant after adjusting for PD and CVD risk factors (standardized β [95% CI]: 0.30 [0.20-0.40], P < 0.001). PD inflammation predicted subsequent MACE (standardized HR [95% CI]: 2.25 [1.47 to 3.44], P <0.001, remaining significant in multivariable models), while periodontal bone loss did not. Furthermore, mediation analysis suggested that arterial inflammation accounts for 80% of the relationship between PD inflammation and MACE (standardized log odds ratio [95% CI]: 0.438 [0.019-0.880], P = 0.022). Conclusion: PD inflammation is independently associated with MACE via a mechanism that may involve increased arterial inflammation. These findings provide important support for an independent relationship between PD inflammation and CVD.

What Are the Clinical and Systemic Results of Periodontitis Treatment in Obese Individuals?

“…Two main characteristics of periodontitis, chronic low-grade inflammation state and potential hematogenous dissemination of bacteria and their endotoxin, such as lipopolysaccharide, may explain the association between periodontal diseases and systemic conditions [ 2 – 4 ]. Particularly, severe periodontitis cases are at higher risk for cardiovascular disease, acute myocardial infarction, and stroke [ 5 ]. Furthermore, the bidirectional relationship between diabetes mellitus and periodontitis is well established, and it is now included in the classification of periodontitis to predict the risk of progression [ 1 ].…”

Periodontitis Is Associated With Risk of Conventional Stent Restenosis: Pilot Case-Control Study

“…Besides having common risk factors, a mechanism linking the two diseases has been elucidated in a recent longitudinal study. Van Dyke et al (38) evaluated the F-fluorodeoxyglucose positron emission tomography/computed tomography of 304 individuals, quantifying periodontal and arterial inflammation. The authors showed that periodontitis is associated with arterial inflammation and that periodontitis predicted subsequent major adverse cardiovascular events (38).…”

“…Van Dyke et al (38) evaluated the F-fluorodeoxyglucose positron emission tomography/computed tomography of 304 individuals, quantifying periodontal and arterial inflammation. The authors showed that periodontitis is associated with arterial inflammation and that periodontitis predicted subsequent major adverse cardiovascular events (38). These findings corroborate the main results of our study, which underscore the hypothesis that periodontitis could influence the occurrence and treatment of CAD.…”

Impact of Periodontitis on Cardiovascular Diseases

“…Scientific meta-analytic studies have found a strong and consistent evidence that PD is associated with atherosclerosis [18] and an increased risk of future CVD events [19]. PD may also worsen pre-existing CVD [20] and treatment of PD appears to diminish CVD risk or its progression [21].…”