Periodontal treatment and vascular inflammation in patients with advanced peripheral arterial disease: A randomized controlled trial

Abstract

Background and aims:Observational studies support an association between periodontitis and cardiovascular diseases. The study objective was to assess vascular inflammation after periodontal treatment in patients with peripheral arterial disease. Methods: Ninety patients with peripheral arterial disease (PAD) and severe periodontitis were enrolled in a randomized, controlled trial. Thirty patients underwent non-surgical periodontal therapy and received additional systemic antibiotics (PT1 group), while 30 patients received the same therapy without antibiotics (PT2 group). The remaining thirty patients did not receive periodontal therapy (CG, control group). The primary outcome of this treatment was a reduction in vascular inflammation three months after periodontal treatment as determined by 18 F-FDG PET/CT values. Secondary outcomes were changes in the inflamed periodontal surface area (PISA) and other periodontal parameters, changes in vascular biomarkers, and adverse cardiovascular events. Results: After three months of treatment, a significant improvement in periodontal health was observed in the treatment groups. However, no difference in the primary outcome in the aorta was observed in the three study groups (median target to background ratio follow-up/baseline, PT1 1.00; 95% CI 0.97-1.10, PT2 1.00; 95% CI 0.98-1.1, CG 1.1; 95% CI 0.99-1.1, p = 0.75). No significant differences were detected in most diseased segments and active segments. In addition, no differences were observed in 18 F-FDG uptake in the carotid, iliac, femoral, and popliteal arteries. No differences with regard to relative changes in vascular biomarkers were noted, and no serious cardiovascular adverse events occurred. Conclusions: Periodontal treatment was effective and safe but did not reduce vascular inflammation in patients with PAD.

Lower Lean Mass Is Associated with Greater Arterial Stiffness in Patients with Lower Extremity Artery Disease

“…Linear regression analysis was performed to assess the influence of lean body mass on arterial stiffness (the cfPWV and AIx) when accounting for the BMI. As patients included in our present study were the screening cohort for a randomized, controlled trial conducted by our study group and published previously [30], no sample size calculation was performed. The statistical analysis was performed in IBM SPSS Statistics version 26 (SPSS Inc., Chicago, IL, USA) and R version 3.6.1 (R Project, Vienna, Austria).…”

Is There a Causal Link Between Periodontitis and Cardiovascular Disease? A Concise Review of Recent Findings

“…Nine intervention studies published in the last 3 years (2018-2020) have addressed the topic of causality between periodontitis and CVD. 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 The major findings of these studies are summarised in Table 1 . Four of these studies used CVD end points, whilst the remainder used surrogate markers for CVD.…”

The year 2020 in Atherosclerosis

“…18 F-FDG-PET/CT vascular imaging is a useful technique in early phase 2 clinical mechanistic studies to assess the impact of potential anti-atherosclerotic therapies on vascular inflammation [60]. Seinost et al [61] conducted a 3-armed, randomised controlled observer-blinded trial to assess the impact of 3-month non-surgical periodontal therapy, with or without antibiotic therapy, on whole-body vascular 18 F-FDG uptake in patients with symptomatic peripheral artery disease. Thirty patients were recruited into each of the 3 arms of the study, and three quarter of the patients were under statins.…”