November 2020, Volume 70, Issue 11

Research Article

Periodontitis is a risk factor for developing cardiovascular diseases

Zeeshan Fatima  ( Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan. )
Chanda Shahzadi  ( Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan. )
Ayesha Nosheen  ( Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan. )
Mirwaise Khan  ( Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan. )
Haseeb-ur-Rehman  ( Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore, Pakistan. )

Abstract

Objective:To find out the link between periodontitis and cardiovascular disease while avoiding chronic infections that lead to heart diseases.

Methods: The case-control study was conducted at a tertiary care hospital in Lahore, Pakistan, from October 5, 2017, to January 5, 2018, and comprised patients of cardiovascular disease and healthy controls. Data was collected using questionnaire- based interviews. Data was analyzed using SPSS 20.

Results:Of the 146 subjects, 73(50%) each were cases and controls. Among the cases, 48(65.75%) had periodontitis, while 25(34.25%) were free from any history or sign of periodontal infections compared to 16(21.91%) controls who had periodontitis and 57(78.08%) who did not have it (p<0.001).

Conclusion: There was a strong association between periodontitis and cardiovascular disease.

Keywords: Risk factors, Periodontitis, Cardiovascular, Diseases, Prevalence. (JPMA 70: 1941; 2020)

DOI: https://doi.org/10.47391/JPMA.12-1265

 

Introduction

 

Oral health offer clues about general health. Periodontitis is one of the commonest diseases that involve the connective tissue destruction and the dental bone loss by periodontal bacteria due to the result of infections in inflammatory hosts.1 Periodontal diseases involve many stages ranging from minor periodontal infections, like gingivitis, to severe periodontitis.2 In the United States, about 75% individuals are affected with this disease.3 This disease is evaluated by the redness of gums, their swelling, inflammation and frequent bleeding of gums. In the US, moderate periodontitis is present in 30% while 10% of the population is affected by advanced form of the disease.4 Systemic inflammation can be elevated by destructive immune response that could be generated by systemic inflammation due to periodontal disease. The periodontal infections and systemic infections, including cardiovascular diseases (CVDs), are related to each other and this relation plays an important part in periodontal researches as clinical backgrounds, systemic inflammatory problems and periodontitis linking with each other is a concept going as far back as the early 1980s.5 The current study was planned to explore this relationship further.

 

Patients and Methods

 

The case-control study was conducted at a tertiary care hospital in Lahore, Pakistan, from October 5, 2017, to January 5, 2018, and comprised CVD patients and healthy controls. The sample size was calculated using epitools software with prevalence rate of 0.453 and odds ratio (OR) of 1.92.6 Patients from the Cardiology Department were considered the cases, while patients from other departments were taken as controls. The simple random sampling method was used to select the samples. Groups were age-matched. Patients with cardiac diseases included coronary artery disease (CAD), cardiomyopathy (CMP), heart valve disease (HVD) and heart attack. Symptoms and other diagnostic tools were used for case selection. Edentulous patients were excluded. Data was collected using face-to-face interviews with the help of a questionnaire that had 4 sections: demographic information; CVD information; periodontitis information; and other potential risk factors. Before collecting information, patients were briefly informed about the questionnaire and purpose of the study. Data was analysed using SPSS 20. ORI was calculated to find the association between periodontitis and specified CVD. Chi-square test was applied to find the association. Different parameters evaluated for the cases were confirmed by clinical diagnosis, while parameters used for periodontitis included gums swelling, bleeding gums, periodontal pockets etc. P<0.05 was considered significant.

 

Results

 

Of the 146 subjects, 73(50%) each were cases and controls. Among the cases, 48(65.75%) had periodontitis, while 25(34.25%) were free from any history or sign of periodontal infections compared to 16(21.91%) controls who had periodontitis while 57(78.08%) did not have it (p<0.001) (Table-1).

CAD, CMP, HVD and heart attack had significant association with periodontitis (Table-2).

 

Discussion

 

The study found that 48 (65.7%) of the cases suffered with periodontitis, indicating a very strong association with periodontitis and heart disease. These results are supported by earlier findings.7,8 Recent evidence has suggested that chronic inflammations, among then dental infections, particularly the periodontal disease, are involved in the pathogenesis of CAD.9 It is an alarming evidence that periodontal diseases could play an important role in the initiation and progression of CVDs.10 HVD is a major public health concern, and a significant rise in its prevalence with age has been observed.11 The present study found a strong association between HVD and periodontitis which is in line with studies showing porphyromonas gingivalis being one of the major opportunistic periodontal pathogens.12 The link between periodontitis and heart attack is inflammation, or swelling, which leads to hardening of arteries, and is called atherosclerosis. The current study showed significant association between the two conditions, and the finding is supported by as earlier study.13 The biological principle that relate periodontitis and myocardial infarction (MI) include direct effects of periodontal bacteria and indirect effects of host mediators, the lipopolysaccharides effects, endotoxins released by the bacteria and effects of activated polysaccharides. A study showed that the vesicles on the outer membrane of porphyromonas (P.) gingivalis were an important feature of CVD formed by lipid cells, and act as oxidation of lowdensity lipopolysaccharides and rupture atherosclerotic plaques.14 Some bacteria of oral microbial habitat, such as P. gingivalis and streptococcus species, have specific surface proteins that are similar to platelets’ activating collagen proteins that aggregate platelets and cause cerebral or cardiac ischaemia when they form a thrombus.15 Other studies have also reported a relationship between periodontitis and MI.17

 

Conclusion

 

The association between periodontitis and CVDs was significant, indicating that periodontitis is a risk factor for CVDs. The finding leads to the convergence of dental and medical cardiac care.

 

Disclaimer: The text is based on an M.Phill thesis.

Conflict of Interest: None.

Source of Funding: None.

 

References

 

1. Zhang L, Henson BS, Camargo PM, Wong DT. The clinical value of salivary biomarkers for periodontal disease. Periodontol 2000. 2009; 51: 25-37.

2. Genco R, Grossi S. Is estrogen deficiency a risk factor for periodontal disease? Compend Contin Educ Dent Suppl 1998; (22): S23-9.

3. Amar S, Gokce N, Morgan S, Loukideli M, Van Dyke TE, Vita JA. Periodontal disease is associated with brachial artery endothelial dysfunction and systemic inflammation. Arteriosclerosis, thrombosis, and vascular Biology 2003; 23: 1245-9.

4. Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med 1992; 326: 242-50.

5. Monsarrat P, Blaizot A, Kémoun P, Ravaud P, Nabet C, Sixou M et al. Clinical research activity in periodontal medicine: a systematic mapping of trial registers. J Clin Periodontol 2016; 43: 390-400.

6. Spahr A, Klein E, Khuseyinova N, Boeckh C, Muche R, Kunze M, et al. Periodontal infections and coronary heart disease: role of periodontal bacteria and importance of total pathogen burden in the Coronary Event and Periodontal Disease (CORODONT) study. Arch Intern Med 2006; 166: 554-9.

7. Demmer RT, Desvarieux M. Periodontal infections and cardiovascular disease: the heart of the matter. J Am Dent Assoc 2006 137: S14-S20.

8. D'aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol 2013; 40 Suppl 14:S85-105.

9. Abou-Raya S, Naeem A, Abou-El KH, El BS. Coronary artery disease and periodontal disease: is there a link?. Angiology 2002; 53: 141-8.

10. Geerts SO, Nys M, Mol PD, Charpentier J, Albert A, Legrand V, et al. Systemic release of endotoxins induced by gentle mastication: association with periodontitis severity. J Periodontol 2002; 73: 73-8.

11. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez- Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368: 1005-11.

12. Marcelino SL, Gaetti-Jardim Jr E, Nakano V, Canônico LA, Nunes FD, Lotufo RF, et al. Presence of periodontopathic bacteria in coronary arteries from patients with chronic periodontitis. Anaerobe 2010; 16: 629-32.

13. Arbes Jr SJ, Slade G, Beck J. Association between extent of periodontal attachment loss and self-reported history of heart attack: an analysis of NHANES III data. J Dent Res 1999; 78: 1777-82.

14. Kuramitsu HK, Qi M, Kang IC, Chen W. Role for periodontal bacteria in cardiovascular diseases. Ann Periodontol 2001; 6: 41-7.

15. Scannapieco FA. Position paper of The American Academy of Periodontology: periodontal disease as a potential risk factor for systemic diseases. J Periodontol 1998; 69: 841-50.

16. Dorn JM, Genco RJ, Grossi SG, Falkner KL, Hovey KM, Iacoviello L, et al. Periodontal disease and recurrent cardiovascular events in survivors of myocardial infarction (MI): the Western New York Acute MI Study. J Periodontol 2010; 81: 502-11.

 

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