Elsevier

Journal of Dentistry

Volume 39, Issue 12, December 2011, Pages 849-854
Journal of Dentistry

Periodontal disease is associated with higher levels of C-reactive protein in non-diabetic, non-smoking acute myocardial infarction patients

https://doi.org/10.1016/j.jdent.2011.09.005Get rights and content

Abstract

Objectives

A link between periodontal disease (PD) and cardiovascular events has been proposed, but confounding by shared risk factors such as smoking and diabetes remains a concern. We examined the prevalence of PD and its contribution to C-reactive protein (CRP) levels in acute myocardial infarction (AMI) patients and in subjects without AMI and with angiographically nonobstructive coronary disease in the absence of these confounding risk factors.

Methods

Periodontal status and admission CRP levels were evaluated in 87 non-diabetic and non-smoking subjects undergoing cardiac catheterization. The study group comprised of 47 patients with documented AMI, and 40 subjects without AMI and with angiographically nonobstructive coronary disease (ANCD group).

Results

Both the prevalence of PD and CRP levels were significantly higher in AMI patients compared with ANCD subjects (38.3% vs. 17.5%, p = 0.03 and 44.3 vs. 8.5 mg/L, p < 0.001 respectively). PD was associated with higher CRP levels in AMI patients (52.5 vs. 36.1 mg/L, p = 0.04) as well as in ANCD subjects, however, in this group this was not significant (12.6 vs. 7.6 mg/L, p = 0.5). Multivariable regression analysis confirmed two separate measures of PD as strong and independent contributors to elevated CRP levels in AMI patients (R2 = 0.28, R2 = 0.30, p = 0.001).

Conclusions

PD contributes to elevated CRP levels in non-diabetic, non-smoking AMI patients, independently of other confounding factors. These findings imply that periodontitis may emerge as a novel target for reducing future risk in AMI survivors.

Introduction

Periodontal disease (PD) is a common, bacterially induced chronic inflammatory oral disease associated with a systemic inflammatory response, evident by elevated systemic CRP levels. In terms of public health implications, the milder form (gingivitis), affects 30%–50% of adults, whilst the severe, generalized and destructive form that is considered PD affects 5%–15% of the adult population.1 The public health burden associated with cardiovascular disease (CVD) has been well documented since it consistently represents the leading cause of death in the developed world.2 An association between PD and CVD has been proposed by several studies, prompting stimulating discussions regarding the possible pathobiologic mechanisms underlying this link but potential confounding introduced by risk factors shared by both conditions, specifically smoking and diabetes remains a concern.3, 4, 5

When reviewing the available studies it appears that a systemic inflammatory response rather than a direct bacterial vascular insult maybe underlying the link between PD and CVD.2 Several studies have demonstrated elevated CRP levels in patients with PD,6, 7 a well established marker for increased cardiovascular risk.8 Specifically, for AMI patients, elevated admission levels of CRP are independently predictive of future events.9 In our study we sought to determine the prevalence of PD and its potential contribution to systemic CRP levels in non-diabetic, non-smoking patients suffering an AMI, as well as in non-diabetic, non-smoking subjects without AMI and with angiographically nonobstructive coronary disease.

Section snippets

Materials and methods

204 consecutive patients diagnosed with AMI and 102 consecutive subjects without AMI and with angiographically nonobstructive coronary disease (<30% luminal stenosis) underwent cardiac catheterization at the First Cardiology Clinic of the Hippokration Hospital, University of Athens. Exclusion criteria included diabetes mellitus, hepatitis or HIV infection, immunosuppressive therapy, current pregnancy or lactation, periodontal therapy in the preceding 6 months, and antibiotic therapy for 3

Statistical analysis

Quantitive data are reported as mean ± SD. The normality of the data distributions was assessed using the Kolmogorov–Smirnov test. Comparisons between AMI cases and control subjects and within each group on the basis of the presence or absence of PD were performed with standard unpaired t-tests. CPK-MB values were not normally distributed and were log transformed and presented as means ± SD. Comparisons regarding the percentage of males and females and the presence/absence of hypertension across

Results

Baseline characteristics for the two groups are shown in Table 1. AMI subjects tended to be older than ANCD subjects (69.6 ± 11.9 years versus 67.9 ± 10.9 years respectively, p = 0.5), but there were no differences in gender, lipid profile (with the exception of HDL), fasting glucose levels, or body mass index in the two groups. AMI cases and ANCD subjects differed significantly in all periodontal parameters examined, including both cumulative measures of past periodontal disease (CAL), as well as

Discussion

There are three main conclusions to our study. First, consistent with previous reports, we found PD to be more frequent in the AMI population compared to the ANCD group.11, 12 Second, again consistent with existing literature, we found that the presence of PD is associated with higher CRP levels both in the AMI patients and ANCD subjects.11 Third, the contribution of PD to CRP elevations was strong, independent of other risk factors and consistent amongst a spectrum of PD measures evaluated.

Conflict of interest

The authors declare that they have no conflict of interest.

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