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Figtree GA, Vernon ST, Harmer JA, Gray MP, Arnott C, Bachour E, Barsha G, Brieger D, Brown A, Celermajer DS, Channon KM, Chew NWS, Chong JJH, Chow CK, Cistulli PA, Ellinor PT, Grieve SM, Guzik TJ, Hagström E, Jenkins A, Jennings G, Keech AC, Kott KA, Kritharides L, Mamas MA, Mehran R, Meikle PJ, Natarajan P, Negishi K, O'Sullivan J, Patel S, Psaltis PJ, Redfern J, Steg PG, Sullivan DR, Sundström J, Vogel B, Wilson A, Wong D, Bhatt DL, Kovacic JC, Nicholls SJ. Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1343-1359. [PMID: 37730292 PMCID: PMC10522922 DOI: 10.1016/j.jacc.2023.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 09/22/2023]
Abstract
Reducing the incidence and prevalence of standard modifiable cardiovascular risk factors (SMuRFs) is critical to tackling the global burden of coronary artery disease (CAD). However, a substantial number of individuals develop coronary atherosclerosis despite no SMuRFs. SMuRFless patients presenting with myocardial infarction have been observed to have an unexpected higher early mortality compared to their counterparts with at least 1 SMuRF. Evidence for optimal management of these patients is lacking. We assembled an international, multidisciplinary team to develop an evidence-based clinical pathway for SMuRFless CAD patients. A modified Delphi method was applied. The resulting pathway confirms underlying atherosclerosis and true SMuRFless status, ensures evidence-based secondary prevention, and considers additional tests and interventions for less typical contributors. This dedicated pathway for a previously overlooked CAD population, with an accompanying registry, aims to improve outcomes through enhanced adherence to evidence-based secondary prevention and additional diagnosis of modifiable risk factors observed.
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Affiliation(s)
- Gemma A Figtree
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia; Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
| | - Stephen T Vernon
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia; Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Jason A Harmer
- Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia; The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia
| | - Michael P Gray
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
| | - Clare Arnott
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Eric Bachour
- Consumer Representative, Agile Group Switzerland AG, Zug, Switzerland
| | - Giannie Barsha
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia
| | - David Brieger
- Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Alex Brown
- National Centre for Indigenous Genomics, Australian National University, Canberra, Australian Capitol Territory, Australia; Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - David S Celermajer
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Keith M Channon
- British Heart Foundation Centre of Research Excellence, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - James J H Chong
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia; Westmead Institute for Medical Research, University of Sydney, Westmead, New South Wales, Australia; Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Westmead, New South Wales, Australia; Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Peter A Cistulli
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia; Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Patrick T Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA; Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stuart M Grieve
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Imaging and Phenotyping Laboratory, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Tomasz J Guzik
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom; Department of Internal Medicine and Omicron Medical Genomics Laboratory, Jagiellonian University Medical College, Krakow, Poland
| | - Emil Hagström
- Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden
| | - Alicia Jenkins
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia; Diabetes and Vascular Medicine, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Garry Jennings
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony C Keech
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Katharine A Kott
- Cardiovascular Discovery Group, Kolling Institute of Medical Research, St Leonards, New South Wales, Australia; Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Leonard Kritharides
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia; The ANZAC Research Institute, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognostic Research, Keele University, Keele, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter J Meikle
- Baker Heart and Diabetes Institute, Melbourne, Vicotria, Australia
| | - Pradeep Natarajan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA; Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Kazuaki Negishi
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia; Department of Cardiology, Nepean Hospital, Kingswood, New South Wales, Australia
| | - John O'Sullivan
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal North Shore Hospital, St Leonards, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia; Precision Cardiovascular Laboratory, University of Sydney, Camperdown, New South Wales, Australia; Heart Research Institute, University of Sydney, Camperdown, New South Wales, Australia
| | - Sanjay Patel
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia; Heart Research Institute, University of Sydney, Camperdown, New South Wales, Australia
| | - Peter J Psaltis
- Vascular Research Centre, Heart and Vascular Program, Lifelong Health Theme, SAHMRI, Adelaide, South Australia, Australia; Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Cardiology, Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Julie Redfern
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia; Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Philippe G Steg
- Université de Paris, Assistance Publique-Hôpitaux de Paris, French Alliance for Cardiovascular Trials and INSERM Unité 1148, Paris, France
| | - David R Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Johan Sundström
- The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, New South Wales, Australia; Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Birgit Vogel
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew Wilson
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Dennis Wong
- Monash Cardiovascular Research Centre, Monash University, Clayton, Victoria, Australia; MonashHeart, Monash Health, Clayton, Victoria, Australia
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Jason C Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Stephen J Nicholls
- Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
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2
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Guo X, Li X, Liao C, Feng X, He T. Periodontal disease and subsequent risk of cardiovascular outcome and all-cause mortality: A meta-analysis of prospective studies. PLoS One 2023; 18:e0290545. [PMID: 37682950 PMCID: PMC10490928 DOI: 10.1371/journal.pone.0290545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/10/2023] [Indexed: 09/10/2023] Open
Abstract
Studies reported periodontal disease (PD) periodontal disease is associated with many systemic diseases, including cardiovascular outcomes and all-cause mortality. However, the precise mechanistic link for these relationship remained unclear. We therefore performed a meta-analysis of cohort studies to investigate the association of PD with the risk of cardiovascular outcomes and all-cause mortality. We systematically searched the databases of PubMed, EmBase, and the Cochrane library to identify eligible studies until April 2023. The investigated outcomes included major adverse cardiovascular events (MACEs), coronary heart disease (CHD), myocardial infarction (MI), stroke, cardiac death, and all-cause mortality. The summary relative risk (RR) with 95% confidence interval (CI) were calculated using the random-effects model. Thirty-nine cohort studies with 4,389,263 individuals were selected for final meta-analysis. We noted PD were associated with elevated risk of MACEs (RR: 1.24; 95%CI: 1.15-1.34; P<0.001), CHD (RR: 1.20; 95%CI: 1.12-1.29; P<0.001), MI (RR: 1.14; 95%CI: 1.06-1.22; P = 0.001), stroke (RR: 1.26; 95%CI: 1.15-1.37; P<0.001), cardiac death (RR: 1.42; 95%CI: 1.10-1.84; P = 0.007), and all-cause mortality (RR: 1.31; 95%CI: 1.07-1.61; P = 0.010). Sensitivity analyses indicated the pooled conclusions for cardiovascular outcomes and all-cause mortality are robustness. The associations of PD with the risk of ardiovascular outcomes and all-cause mortality could affected by region, study design, PD definition, follow-up duration, and study quality. This study found the risk of cardiovascular outcomes and all-cause mortality were elevated in PD patients, and the intervention for PD should be applied to prevent the risk of cardiovascular outcomes.
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Affiliation(s)
- Xiangyu Guo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral DiseasesWest China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xue Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral DiseasesWest China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Chunjuan Liao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral DiseasesWest China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xingyu Feng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral DiseasesWest China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Tao He
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral DiseasesWest China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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3
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Alwithanani N. Periodontal Diseases and Heart Diseases: A Systemic Review. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S72-S78. [PMID: 37654288 PMCID: PMC10466634 DOI: 10.4103/jpbs.jpbs_517_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/07/2023] [Accepted: 03/03/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Up to 50% of people worldwide are affected by periodontal disease (PD); cardiovascular diseases are a serious concern for the major portion of the world's population. Observational data have shown a connection between PD and CVD. The current systemic review investigates the incidence of the CVD in individuals with PD through various designs of the previous research. Materials and Methods An extensive online search in the various databanks of EMBASE, Medline, Pubmed, and Scopus was conducted. The keywords searched were: "PD, CVD, myocardial infarction, coronary heart disease (CHD), and stroke; technique of diagnosis and the degree of PD were assessed clinically or by self-report." The studies selected were longitudinal research design and randomized trials. To ascertain the risk of mortality due to cardiac issues in periodontal diseases, meta-analysis, and meta-regression were carried out. The diagnosis techniques for periodontal diseases, severity, and impact of gender, were also examined. Results After full-text screening, 32 longitudinal cohort studies were included. PD patients had a significantly greater risk of CVD than non-PD patients (RR: 1.20). Clinical and self-reported PD diagnoses did not differ in CVD risk (RR = 0.97). Men were at increased risk for both severe PD (RR: 1.25), and CVD (RR: 1.16). The risk of stroke was the highest among all forms of CVD (RR = 1.24), and the risk of CHD was significantly elevated (RR = 1.14). Conclusion Current review showed that populations with PD consistently and modestly have an elevated risk of CVD. Men and those with severe PD are at higher CVD risk, which suggests population-targeted therapies may be helpful.
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Affiliation(s)
- Naif Alwithanani
- Department of Oral and Maxillofacial Surgery and Diagnostic Science, Taif University, Taif, Saudi Arabia
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4
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Yan Y, Mao M, Li YQ, Chen YJ, Yu HD, Xie WZ, Huang Q, Leng WD, Xiong J. Periodontitis Is Associated With Heart Failure: A Population-Based Study (NHANES III). Front Physiol 2022; 13:854606. [PMID: 35514329 PMCID: PMC9065405 DOI: 10.3389/fphys.2022.854606] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of this study was to investigate the relationship between periodontitis and heart failure using the Third National Health and Nutrition Examination Survey (NHANES III). Methods: Participants who had received a periodontal examination were included and investigated for the occurrence of heart failure. The included participants were divided into no/mild periodontitis and moderate/severe periodontitis groups according to their periodontal status. Weighted prevalence of heart failure was calculated, and weighted logistic regressions models were used to explore the association between periodontitis and heart failure. Possible influencing factors were then explored through subgroup analysis. Results: Compared with that of the no/mild periodontitis group, the incidence of heart failure in participants with moderate/severe periodontitis was 5.72 times higher (95% CI: 3.76-8.72, p < 0.001). After adjusting for gender, age, race, body mass index, poverty income ratio, education, marital status, smoking status, drinking status, hypertension, diabetes, stroke, and asthma, the results showed that the incidence of heart failure in the moderate/severe group was 3.03 times higher (95% CI: 1.29-7.13, p = 0.012). Subgroup analysis showed that criteria, namely, male, 40-60 years old, non-Hispanic white, body mass index >30, poverty income ratio ≥1, not more than 12 years of education, currently drinking, stroke but no diabetes, or asthma supported moderate/severe periodontitis as a risk factor for heart failure (p < 0.05). Conclusion: According to data from this nationally representative sample from the United States, periodontitis is associated with an increased risk of heart failure.
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Affiliation(s)
- Yan Yan
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Min Mao
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yan-Qin Li
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Yong-Ji Chen
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - He-Dong Yu
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Wen-Zhong Xie
- Department of Stomatology, Kaifeng University Health Science Center, Kaifeng, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wei-Dong Leng
- Department of Stomatology, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jie Xiong
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
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Gao K, Wu Z, Liu Y, Tao L, Luo Y, Yang X, Zhang J, Guo X, Wang S. Risk of coronary heart disease in patients with periodontitis among the middled-aged and elderly in China: a cohort study. BMC Oral Health 2021; 21:621. [PMID: 34876078 PMCID: PMC8650264 DOI: 10.1186/s12903-021-01951-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Convincing evidence of the periodontitis as a risk factor for coronary heart disease (CHD) is lacking due to shared risk factors, and no cohort study has investigated the association between CHD and periodontitis in Chinese populations. METHODS This study used a prospective cohort study design. The analysis included 4591 participants aged 40 years and older (3146 men and 1445 women). The association between CHD and periodontitis was estimated using relative risk (RR) calculated using modified Poisson regression. Multiple mediation analysis was used to differentiate the relative effects (RE) from different risk factors on the effect of periodontitis on CHD. RESULTS In the analysis using the imputed dataset and fully adjusted model, participants with periodontitis at baseline had 37% increased risk of CHD overall compared to those without periodontitis at baseline (RR 1.37; 95% CI 0.96-1.95). Most of the association can be explained by age, sex, history of diabetes, history of hypertension, uric acid and education (RE 0.76; 95% CI 0.41-1.02). CONCLUSION Periodontitis was weakly associated with an increased risk of CHD among the middled-aged and elderly in China. Further studies are required to identify more mediators and elucidate the mechanisms of how periodontitis increases the risk of CHD.
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Affiliation(s)
- Kaikai Gao
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
- Beijing Laboratory of Oral Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
- National Institute for Data Science in Health and Medicine, Capital Medical University, Beijing, China
| | - Zhiyuan Wu
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
| | - Yue Liu
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
| | - Lixin Tao
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yanxia Luo
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Xinghua Yang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Jingbo Zhang
- Beijing Physical Examination Center, Beijing, China
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.
- National Institute for Data Science in Health and Medicine, Capital Medical University, Beijing, China.
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, Beijing, China.
- Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China.
| | - Songlin Wang
- Beijing Laboratory of Oral Health, Capital Medical University, No.10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.
- Department of Biochemistry and Molecular Biology, Capital Medical University School of Basic Medical Sciences, Beijing, People's Republic of China.
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Ning W, Ma Y, Li S, Wang X, Pan H, Wei C, Zhang S, Bai D, Liu X, Deng Y, Acharya A, Pelekos G, Savkovic V, Li H, Gaus S, Haak R, Schmalz G, Ziebolz D, Ma Y, Xu Y. Shared Molecular Mechanisms between Atherosclerosis and Periodontitis by Analyzing the Transcriptomic Alterations of Peripheral Blood Monocytes. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:1498431. [PMID: 34899963 PMCID: PMC8664523 DOI: 10.1155/2021/1498431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/12/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study investigated the nature of shared transcriptomic alterations in PBMs from periodontitis and atherosclerosis to unravel molecular mechanisms underpinning their association. METHODS Gene expression data from PBMs from patients with periodontitis and those with atherosclerosis were each downloaded from the GEO database. Differentially expressed genes (DEGs) in periodontitis and atherosclerosis were identified through differential gene expression analysis. The disease-related known genes related to periodontitis and atherosclerosis each were downloaded from the DisGeNET database. A Venn diagram was constructed to identify crosstalk genes from four categories: DEGs expressed in periodontitis, periodontitis-related known genes, DEGs expressed in atherosclerosis, and atherosclerosis-related known genes. A weighted gene coexpression network analysis (WGCNA) was performed to identify significant coexpression modules, and then, coexpressed gene interaction networks belonging to each significant module were constructed to identify the core crosstalk genes. RESULTS Functional enrichment analysis of significant modules obtained by WGCNA analysis showed that several pathways might play the critical crosstalk role in linking both diseases, including bacterial invasion of epithelial cells, platelet activation, and Mitogen-Activated Protein Kinases (MAPK) signaling. By constructing the gene interaction network of significant modules, the core crosstalk genes in each module were identified and included: for GSE23746 dataset, RASGRP2 in the blue module and VAMP7 and SNX3 in the green module, as well as HMGB1 and SUMO1 in the turquoise module were identified; for GSE61490 dataset, SEC61G, PSMB2, SELPLG, and FIBP in the turquoise module were identified. CONCLUSION Exploration of available transcriptomic datasets revealed core crosstalk genes (RASGRP2, VAMP7, SNX3, HMGB1, SUMO1, SEC61G, PSMB2, SELPLG, and FIBP) and significant pathways (bacterial invasion of epithelial cells, platelet activation, and MAPK signaling) as top candidate molecular linkage mechanisms between atherosclerosis and periodontitis.
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Affiliation(s)
- Wanchen Ning
- Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - Yihong Ma
- Department of Neurology, Graduate School of Medical Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Simin Li
- Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
| | - Xin Wang
- Department of Neurology, First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Hongying Pan
- School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI 48109, USA
| | - Chenxuan Wei
- School of Dentistry, University of Michigan, 1011 N University Ave, Ann Arbor, MI 48109, USA
| | - Shaochuan Zhang
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Dongying Bai
- College of Animal Science and Technology, Henan University of Science and Technology, Luoyang 471003, China
| | - Xiangqiong Liu
- Laboratory of Molecular Cell Biology, Beijing Tibetan Hospital, China Tibetology Research Center, 218 Anwaixiaoguanbeili Street, Chaoyang, Beijing 100029, China
| | - Yupei Deng
- Laboratory of Molecular Cell Biology, Beijing Tibetan Hospital, China Tibetology Research Center, 218 Anwaixiaoguanbeili Street, Chaoyang, Beijing 100029, China
| | - Aneesha Acharya
- Dr D Y Patil Dental College and Hospital, Dr D Y Patil Vidyapeeth, Pimpri, Pune, India
| | - George Pelekos
- Faculty of Dentistry, University of Hong Kong, Hong KongChina
| | - Vuk Savkovic
- Department of Cranio Maxillofacial Surgery, University Clinic Leipzig, Liebigstr. 12, 04103 Leipzig, Germany
| | - Hanluo Li
- Department of Cranio Maxillofacial Surgery, University Clinic Leipzig, Liebigstr. 12, 04103 Leipzig, Germany
| | - Sebastian Gaus
- Department of Cranio Maxillofacial Surgery, University Clinic Leipzig, Liebigstr. 12, 04103 Leipzig, Germany
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany
| | - Gerhard Schmalz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany
| | - Dirk Ziebolz
- Department of Cariology, Endodontology and Periodontology, University of Leipzig, 04103 Leipzig, Germany
| | - Yanbo Ma
- College of Animal Science and Technology, Henan University of Science and Technology, Luoyang 471003, China
| | - Yuzhen Xu
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong First Medical University, Taian, Shandong Province 271000, China
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7
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Gao S, Tian J, Li Y, Liu T, Li R, Yang L, Xing Z. Periodontitis and Number of Teeth in the Risk of Coronary Heart Disease: An Updated Meta-Analysis. Med Sci Monit 2021; 27:e930112. [PMID: 34421117 PMCID: PMC8394608 DOI: 10.12659/msm.930112] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background A positive link between periodontitis and chronic systemic disease has been indicated. However, few studies focused on the loss of teeth. Our analysis aims to analyze the relationship of periodontitis and number of teeth with the risk of coronary heart disease (CHD). Material/Methods A meta-analysis was conducted on qualified data extracted from the PubMed, Embase, and Cochrane Library databases. Only cohort studies were included in this study. We screened articles that assessed the periodontal condition and teeth number as well as the incidence or mortality of CHD. Hazard ratio (HR) and relative risk (RR) were calculated by Stata SE software. Results A total of 11 prospective studies with over 200 000 total participants were analyzed. Ten studies reported on periodontitis and CHD, and 4 studies included data on number of teeth. After adjusting for multivariate factors, there was a significant association between periodontitis and the risk of CHD (RR, 1.18; 95% confidence interval [CI], 1.10–1.26); the RR of CHD in the edentulous population was 1.20 (95% CI, 1.08–1.34). Moreover, results on the RR values for number of teeth were as follows: 24–17 teeth (RR, 1.12; 95% CI, 1.05–1.19); 16–11 (RR, 1.28; 95% CI, 1.15–1.42); and ≤10 (RR, 1.55; 95% CI, 1.43–1.69). Conclusions Our study showed that periodontitis is a risk factor for CHD and that the number of removed teeth is positively correlated with the risk of CHD. During clinical assessment, both factors need to be considered as factors associated with cardiovascular risks.
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Affiliation(s)
- Shuting Gao
- School of Stomatology, Lanzhou University, Lanzhou, Gansu, China (mainland)
| | - Jinhui Tian
- Center of Evidence-Based Medicine, Lanzhou University, Lanzhou, Gansu, China (mainland)
| | - Yiting Li
- School of Stomatology, Lanzhou University, Lanzhou, Gansu, China (mainland)
| | - Tingjie Liu
- School of Stomatology, Lanzhou University, Lanzhou, Gansu, China (mainland)
| | - Ruiping Li
- School of Stomatology, Lanzhou University, Lanzhou, Gansu, China (mainland)
| | - Lan Yang
- Department of Oral and Maxillofacial, Secondary Hospital of Lanzhou University, Lanzhou, Gansu, China (mainland)
| | - Zhankui Xing
- Department of Oral and Maxillofacial, Secondary Hospital of Lanzhou University, Lanzhou, Gansu, China (mainland)
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8
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Beukers NGFM, Su N, Loos BG, van der Heijden GJMG. Lower Number of Teeth Is Related to Higher Risks for ACVD and Death-Systematic Review and Meta-Analyses of Survival Data. Front Cardiovasc Med 2021; 8:621626. [PMID: 34026863 PMCID: PMC8138430 DOI: 10.3389/fcvm.2021.621626] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Tooth loss reflects the endpoint of two major dental diseases: dental caries and periodontitis. These comprise 2% of the global burden of human diseases. A lower number of teeth has been associated with various systemic diseases, in particular, atherosclerotic cardiovascular diseases (ACVD). The aim was to summarize the evidence of tooth loss related to the risk for ACVD or death. Cohort studies with prospective follow-up data were retrieved from Medline-PubMed and EMBASE. Following the PRISMA guidelines, two reviewers independently selected articles, assessed the risk of bias, and extracted data on the number of teeth (tooth loss; exposure) and ACVD-related events and all-cause mortality (ACM) (outcome). A total of 75 articles were included of which 44 were qualified for meta-analysis. A lower number of teeth was related to a higher outcome risk; the pooled risk ratio (RR) for the cumulative incidence of ACVD ranged from 1.69 to 2.93, and for the cumulative incidence of ACM, the RR ranged from 1.76 to 2.27. The pooled multiple adjusted hazard ratio (HR) for the incidence density of ACVD ranged from 1.02 to 1.21, and for the incidence density of ACM, the HR ranged from 1.02 to 1.30. This systematic review and meta-analyses of survival data show that a lower number of teeth is a risk factor for both ACVD and death. Health care professionals should use this information to inform their patients and increase awareness on the importance of good dental health and increase efforts to prevent tooth loss.
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Affiliation(s)
- Nicky G F M Beukers
- Academic Centre for Dentistry Amsterdam, Department of Periodontology, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Naichuan Su
- Academic Centre for Dentistry Amsterdam, Department of Social Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bruno G Loos
- Academic Centre for Dentistry Amsterdam, Department of Periodontology, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Geert J M G van der Heijden
- Academic Centre for Dentistry Amsterdam, Department of Social Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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9
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Haworth S, Esberg A, Kuja-Halkola R, Lundberg P, Magnusson PKE, Johansson I. Using national register data to estimate the heritability of periodontitis. J Clin Periodontol 2021; 48:756-764. [PMID: 33745184 DOI: 10.1111/jcpe.13459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/25/2021] [Accepted: 03/07/2021] [Indexed: 12/24/2022]
Abstract
AIM To identify whether periodontal traits derived from electronic dental records are biologically informative and heritable. MATERIALS AND METHODS The study included 11,974 adult twins (aged 30-92 years) in the Swedish Twin Registry. Periodontal records from dental examinations were retrieved from a national register and used to derive continuous measures of periodontal health. A latent class approach was used to derive categorial measures of periodontal status. The correlation patterns in these traits were contrasted in monozygotic and dizygotic twin pairs using quantitative genetic models to estimate the heritability of the traits. RESULTS For continuous traits, heritability estimates ranged between 41.5% and 48.3% with the highest estimates for number of missing tooth surfaces and rate of change in number of deep periodontal pockets (≥6 mm). For categorial traits, the latent class approach identified three classes (good periodontal health, mild periodontitis signs and severe signs of periodontitis) and there was a clear difference in the hazard for subsequent tooth loss between these three classes. Despite this, the class allocations were only slightly more heritable than a conventional dichotomous disease definition (45.2% vs. 42.6%). CONCLUSIONS Periodontitis is a moderately heritable disease. Quantitative periodontal traits derived from electronic records are an attractive target for future genetic association studies.
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Affiliation(s)
- Simon Haworth
- Medical Research Council Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Bristol Dental School, University of Bristol, Bristol, UK
| | - Anders Esberg
- Department of Odontology, Umeå University, Umeå, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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10
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Choi H, Dey AK, Priyamvara A, Aksentijevich M, Bandyopadhya D, Dey D, Dani S, Guha A, Nambiar P, Nasir K, Jneid H, Mehta NN, Lavie C, Amar S. Role of Periodontal Infection, Inflammation and Immunity in Atherosclerosis. Curr Probl Cardiol 2021; 46:100638. [PMID: 32646544 PMCID: PMC8761259 DOI: 10.1016/j.cpcardiol.2020.100638] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammation plays a major role in the development and progression of cardiovascular disease (CVD) morbidity and mortality. The well-established relationship between periodontal disease (PD) and CVD may be causal. Left untreated, PD can lead to high systemic inflammation, thus contributing to inflammatory CVD, such as atherosclerosis. Multiple mechanisms have been proposed to elucidate the causal relationship between PD and its contribution to CVD. OBJECTIVE This review article highlights the current evidence supporting the role of PD in the development and progression of atherosclerosis. METHODS After creating a list of relevant medical subject heading (MeSH) terms, a systematic search within PubMed in English for each MeSH term between 2000 and 2019 was used to generate evidence for this review article. CONCLUSION There is overwhelming evidence in the current literature that supports an association between PD and CVD that is independent of known CVD risk factors. However, the supporting evidence that PD directly causes CVD in humans continues to remain elusive. Multiple biologically plausible mechanisms have been proposed and investigated, yet most studies are limited to mouse models and in vitro cell cultures. Additional studies testing the various proposed mechanisms in longitudinal human studies are required to provide deeper insight into the mechanistic link between these 2 related diseases.
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Affiliation(s)
- Harry Choi
- National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Amit K. Dey
- National Heart Lung and Blood Institute, Bethesda, MD, USA
| | | | | | | | | | | | | | | | | | | | - Nehal N. Mehta
- National Heart Lung and Blood Institute, Bethesda, MD, USA
| | - Carl Lavie
- Ochsner Clinical School-UQ School of Medicine, New Orleans, LA, USA
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11
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Tiensripojamarn N, Lertpimonchai A, Tavedhikul K, Udomsak A, Vathesatogkit P, Sritara P, Charatkulangkun O. Periodontitis is associated with cardiovascular diseases: A 13-year study. J Clin Periodontol 2021; 48:348-356. [PMID: 33386631 DOI: 10.1111/jcpe.13418] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 09/25/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
AIM To prospectively evaluate the association between periodontitis and the incidence of cardiovascular diseases (CVDs) in Thai adults. MATERIALS AND METHODS Medical data from the questionnaires and physical examinations of 1850 participants aged 47-73 years from EGAT study were gathered. Random half-mouth periodontal examination of each participant was performed by calibrated periodontists, and periodontal status was defined. The incidence of new CVD events, including coronary heart disease (CHD) and stroke, was verified by cardiologists. The Cox proportional hazard regression model was used to estimate hazard ratios (HRs). RESULTS The prevalence of no/mild, moderate and severe periodontitis in the study participants was 11.7%, 52.7% and 35.6%, respectively. During the 13-year follow-up, CVD events occurred in 110 (5.9%) participants, with 82 (4.4%) from CHD and 28 (1.5%) from stroke. After adjusting for cardiovascular risk factors, a significant association between severe periodontitis and the incidence of CHD was found compared with the no/mild periodontitis group with an HR of 4.53 (95% confidence intervals: 1.08-19.02). However, no significant association was seen when considering total CVD events and stroke outcome. CONCLUSIONS This study demonstrates that severe periodontitis is associated with an increased incidence of CHD, independent of established cardiovascular risk factors.
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Affiliation(s)
| | - Attawood Lertpimonchai
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Kanoknadda Tavedhikul
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
| | - Artit Udomsak
- Electricity Generating Authority of Thailand, Nonthaburi, Thailand
| | | | | | - Orawan Charatkulangkun
- Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Periodontal Disease and Dental Implant, Chulalongkorn University, Bangkok, Thailand
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12
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Zardawi F, Gul S, Abdulkareem A, Sha A, Yates J. Association Between Periodontal Disease and Atherosclerotic Cardiovascular Diseases: Revisited. Front Cardiovasc Med 2021; 7:625579. [PMID: 33521070 PMCID: PMC7843501 DOI: 10.3389/fcvm.2020.625579] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/17/2020] [Indexed: 01/15/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ACVD) is an inflammatory disease of the coronary arteries associated with atheroma formation, which can cause disability and often death. Periodontitis is ranked as the sixth most prevalent disease affecting humans affecting 740 million people worldwide. In the last few decades, researchers have focused on the effect of periodontal disease (PD) on cardiovascular disease. The aim of this review was to investigate the association between these two diseases. PD is a potential risk factor that may initiate the development, maturation, and instability of atheroma in the arteries. Two mechanisms were proposed to explain such association, either periodontal pathogens directly invade bloodstream or indirectly by increasing systemic level of inflammatory mediators. Interestingly, it has been suggested that improvement in the condition of one disease positively impact the condition of the other one. Highlighting the association between these two diseases, the importance of early diagnosis and treatment of PD and its impact on cardiovascular status may be of great value in reducing the complications associated with ACVDs. Further in vitro and in vivo studies with longer follow up are necessary to confirm the causal relationship between PD and ACVDs.
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Affiliation(s)
- Faraedon Zardawi
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Sarhang Gul
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Ali Abdulkareem
- Department of Periodontics, College of Dentistry, University of Baghdad, Baghdad, Iraq
| | - Aram Sha
- Periodontics Department, College of Dentistry, University of Sulaimani, Sulaymaniyah, Iraq
| | - Julian Yates
- Division of Dentistry, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
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13
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Darabi Z, Najafi F, Safari-Faramani R, Salimi Y. Controlled direct effect of psychiatric disorders on cardiovascular disease: evidence from a large Kurdish cohort. BMC Cardiovasc Disord 2020; 20:501. [PMID: 33256607 PMCID: PMC7706104 DOI: 10.1186/s12872-020-01794-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background Psychiatric disorders are significantly associated with the incidence and prevalence of cardiovascular diseases, mortality, hospital readmissionn. Oral and dental hygiene may play a role in such association. This study aimed to evaluate the controlled direct effect of psychiatric disorders on cardiovascular diseases by controlling the mediating effect of oral and dental hygiene. Methods The data used for this study came from the baseline phase of Ravansar Non-communicable Disease (RaNCD) cohort study. RaNCD cohort study is including a representative sample of 10,065 adults (35–65 years old) living in Ravansar, a city in the west of Iran. The marginal structural model with stabilized inverse probability weights accounted for potential confounders was used to estimate the controlled direct effect of psychiatric disorders on cardiovascular diseases. Three different models using three mediators including oral and dental hygiene behaviors, oral ulcer and lesions, and decayed, missing, and filled tooth, were used. Results Psychiatric disorders increase the odds of cardiovascular diseases by 83% (OR = 1.83, CI 1.27, 2.61) and about two times (OR = 2.14, 95% CI 1.74, 2.63) when controlled for oral and dental hygiene behaviors, and oral ulcer and lesions as mediators, respectively. When decayed, missing, and filled tooth, as a mediator, was set at ≤ 8, there was no statistically significant controlled direct effect of psychiatric disorders on cardiovascular diseases (OR = 0.90, 95% CI 0.62, 1.30). Conclusion Our results suggested that psychiatric disorder was directly related to cardiovascular diseases even if it was possible to have good oral and dental hygiene. The results suggested that interventions targeting people with psychiatric disorders could reduce prevalence of the cardiovascular diseases.
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Affiliation(s)
- Zahra Darabi
- Department of Epidemiology, School of Public Health, Kermanshah University of Medical Sciences, 6719851351, Kermanshah, Iran
| | - Farid Najafi
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, 6719851351, Kermanshah, Iran
| | - Roya Safari-Faramani
- Department of Epidemiology, Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, 6719851351, Kermanshah, Iran
| | - Yahya Salimi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, 6719851351, Kermanshah, Iran.
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14
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Larvin H, Kang J, Aggarwal VR, Pavitt S, Wu J. Risk of incident cardiovascular disease in people with periodontal disease: A systematic review and meta-analysis. Clin Exp Dent Res 2020; 7:109-122. [PMID: 33124761 PMCID: PMC7853902 DOI: 10.1002/cre2.336] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/02/2020] [Accepted: 09/27/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Cardiovascular disease (CVD) is a major cause of mortality; periodontal disease (PD) affects up to 50% of the world's population. Observational evidence has demonstrated association between CVD and PD. Absent from the literature is a systematic review and meta-analysis of longitudinal cohort studies quantifying CVD risk in PD populations compared to non-PD populations. To examine the risk of incident CVD in people with PD in randomised controlled trials and longitudinal cohort studies. MATERIAL AND METHODS We searched Medline, EMBASE and Cochrane databases up to 9th Oct 2019 using keywords and MeSH headings using the following concepts: PD, CVD, longitudinal and RCT study design. CVD outcomes included but were not restricted to any CVD, myocardial infarction, coronary heart disease (CHD) and stroke. Diagnosis method and severity of PD were measured either clinically or by self-report. Studies comparing incident CVD in PD and non-PD populations were included. Meta-analysis and meta-regression was performed to determine risk of CVD in PD populations and examine the effects of PD diagnosis method, PD severity, gender and study region. RESULTS Thirty-two longitudinal cohort studies were included after full text screening; 30 were eligible for meta-analysis. The risk of CVD was significantly higher in PD compared to non-PD (relative risk [RR]: 1.20, 95% CI: 1.14-1.26). CVD risk did not differ between clinical or self-reported PD diagnosis (RR = 0.97, 95% CI: 0.87-1.07,). CVD risk was higher in men (RR: 1.16, 95% CI: 1.08-1.25) and severe PD (RR: 1.25, 95% CI: 1.15-1.35). Among all types of CVD, the risk of stroke was highest (RR = 1.24; 95% CI:1.12-1.38), the risk of CHD was also increased (RR = 1.14; 95% CI:1.08-1.21). CONCLUSION This study demonstrated modest but consistently increased risk of CVD in PD populations. Higher CVD risk in men and people with severe PD suggests population-targeted interventions could be beneficial.
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Affiliation(s)
| | - Jing Kang
- Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | | | - Sue Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- School of Dentistry, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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15
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Nibali L, Bayliss-Chapman J, Almofareh SA, Zhou Y, Divaris K, Vieira AR. What Is the Heritability of Periodontitis? A Systematic Review. J Dent Res 2020; 98:632-641. [PMID: 31107142 DOI: 10.1177/0022034519842510] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to systematically appraise the existing literature on the yet-unclear heritability of gingivitis and periodontitis. This review was conducted following the PRISMA guidelines. A search was conducted through the electronic databases Medline, Embase, LILACS, Cochrane Library, Open Grey, Google Scholar, and Research Gate, as complemented by a hand search, for human studies reporting measures of heritability of gingivitis and periodontitis. A total of 9,037 papers were initially identified from combined databases and 10,810 on Google Scholar. After full-text reading, 28 articles met the inclusion criteria and were carried forward to data abstraction. The reviewed data included information from >50,000 human subjects. Meta-analyses were performed by grouping studies based on design and outcome. Heritability ( H2) of periodontitis was estimated at 0.38 (95% CI, 0.34 to 0.43; I2 = 12.9%) in twin studies, 0.15 (95% CI, 0.06 to 0.24; I2 = 0%) in other family studies, and 0.29 (95% CI, 0.21 to 0.38; I2 = 61.2%) when twin and other family studies were combined. Genome-wide association studies detected a lower heritability estimate of 0.07 (95% CI, -0.02 to 0.15) for combined definitions of periodontitis, increasing with disease severity and when the interaction with smoking was included. Furthermore, heritability tended to be lower among older age groups. Heritability for the self-reported gingivitis trait was estimated at 0.29 (95% CI, 0.22 to 0.36; I2 = 37.6%), while it was not statistically significant for clinically measured gingivitis. This systematic review brings forward summary evidence to confirm that up to a third of the periodontitis variance in the population is due to genetic factors. This seems consistent across the different studied populations and increases with disease severity. In summary, up to a third of the variance of periodontitis in the population is due to genetic factors, with higher heritability for more severe disease.
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Affiliation(s)
- L Nibali
- 1 Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University London, London, UK
| | - J Bayliss-Chapman
- 1 Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University London, London, UK
| | - S A Almofareh
- 1 Centre for Oral Immunobiology and Regenerative Medicine, Centre for Oral Clinical Research, Institute of Dentistry, Queen Mary University London, London, UK
| | - Y Zhou
- 2 Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - K Divaris
- 3 Department of Pediatric Dentistry, School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.,4 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - A R Vieira
- 2 Department of Oral Biology, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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16
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Holtfreter B, Samietz S, Hertrampf K, Aarabi G, Hagenfeld D, Kim TS, Kocher T, Koos B, Schmitter M, Ahrens W, Alwers E, Becher H, Berger K, Brenner H, Damms-Machado A, Ebert N, Fischer B, Franzke CW, Frölich S, Greiser H, Gies A, Günther K, Hassan L, Hoffmann W, Jaeschke L, Keil T, Kemmling Y, Krause G, Krist L, Legath N, Lieb W, Leitzmann M, Linseisen J, Loeffler M, Meinke-Franze C, Michels KB, Mikolajczyk R, Obi N, Peters A, Pischon T, Schipf S, Schmidt B, Völzke H, Waniek S, Wigmann C, Wirkner K, Schmidt CO, Kühnisch J, Rupf S. Design und Qualitätskontrolle der zahnmedizinischen Untersuchung in der NAKO Gesundheitsstudie. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:426-438. [DOI: 10.1007/s00103-020-03107-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Zusammenfassung
Hintergrund
Karies und Parodontitis sind weltweit hoch prävalente Erkrankungen. Durch ihre Erfassung im Rahmen der NAKO Gesundheitsstudie können Assoziationen zwischen oralen und systemischen Erkrankungen untersucht werden.
Fragestellung
In einer ersten Qualitätsanalyse zur Halbzeit der NAKO-Basiserhebung wird die Plausibilität der zahnmedizinischen Ergebnisse überprüft. Es werden Maßnahmen zur Verbesserung der Datenqualität vorgeschlagen.
Material und Methoden
Ein zahnmedizinisches Interview, eine Speichelprobengewinnung und eine Befunderhebung wurden durchgeführt. Im Rahmen der Level-1-Untersuchung wurden Zahn- und Prothesenanzahl erfasst. In der Level-2-Untersuchung wurden detaillierte parodontologische, kariologische und funktionelle Befunde erhoben. Alle Untersuchungen wurden von geschultem nichtzahnmedizinischen Personal durchgeführt. Es wurden Plausibilitätsprüfungen durchgeführt sowie Verteilungen deskriptiv dargestellt.
Ergebnisse
In die Analysen gingen Daten von 57.967 Interviewteilnehmer*innen, 56.913 Level-1- und 6295 Level-2-Teilnehmer*innen ein. Der Anteil fehlender Werte lag für die einzelnen Parameter der Level-1- und Level-2-Untersuchungen zwischen 0,02 % und 3,9 %. Die Parameter zeigten eine plausible Verteilung; vereinzelt wurden unplausible Werte beobachtet, z. B. beim horizontalen und vertikalen Überbiss (Overjet und Overbite). Anhand der Intraklassenkorrelationskoeffizienten wurden für die einzelnen Parameter Unterschiede zwischen regionalen Clustern, den Studienzentren und verschiedenen Untersucher*innen nachgewiesen.
Diskussion
Die bisherigen Ergebnisse bestätigten die Umsetzbarkeit des Studienprotokolls durch nichtzahnmedizinisches Personal und die erfolgreiche Integration in das Untersuchungsprogramm der NAKO Gesundheitsstudie. Die Studienzentren benötigen eine intensive zahnmedizinische Betreuung für das Qualitätsmanagement.
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17
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Håheim LL, Nafstad P, Schwarze PE, Olsen I, Rønningen KS, Thelle DS. Oral health and cardiovascular disease risk factors and mortality of cerebral haemorrhage, cerebral infarction and unspecified stroke in elderly men: A prospective cohort study. Scand J Public Health 2019; 48:762-769. [PMID: 31814529 DOI: 10.1177/1403494819879351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: Stroke mortality comprises different specific diagnoses as cerebral infarction, different haemorrhagic conditions and unspecified stroke. This study seeks to explore the prediction of oral health indicators versus known cardiovascular disease risk factors for stroke mortality. Methods: Altogether, 12,764 men aged 58 to 77 years were invited to the health screening Oslo II in the year 2000. It included general medical measurements and questionnaire information. Mortality data were supplied by Statistics Norway for the 6530 attending men. Cox proportional hazards regression analyses were used to establish prediction models for mortality. Results: Oral health by number of tooth extractions >10 was found to be an independent predictor for cerebral infarction hazard ratio = 2.92, 95% confidence interval (1.24-6.89). This was independent of HDL-Cholesterol (inversely) hazard ratio = 0.21, 95% confidence interval (0.06-0.76), frequent alcohol consumption (drinking 4-7 times per week) hazard ratio = 3.58, 95% confidence interval (1.40-9.13) and diabetes hazard ratio = 4.28, 95% confidence interval (1.68-10.89). Predictors for cerebral haemorrhage were age, hs-C-reactive protein and body mass index (inversely). Age and total cholesterol (inversely) were predictors for unspecified stroke. Conclusions: Oral health measured by number of tooth extractions >10 was an independent predictor for cerebral infarction in addition to age, HDL-C, hs-C-reactive protein and diabetes. The pattern of risk factors varied between the specific stroke diagnoses.
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Affiliation(s)
- Lise Lund Håheim
- Department of Oral Biology, Dental Faculty, University of Oslo, Norway
| | - Per Nafstad
- Department of Chronic Diseases and Ageing (PN), Division of Infection Control and Environmental Health (PES), Norwegian Institute for Public Health, Norway.,Medical Faculty, Institute of Health and Society, University of Oslo, Norway
| | - Per E Schwarze
- Department of Chronic Diseases and Ageing (PN), Division of Infection Control and Environmental Health (PES), Norwegian Institute for Public Health, Norway
| | - Ingar Olsen
- Department of Oral Biology, Dental Faculty, University of Oslo, Norway
| | - Kjersti S Rønningen
- Department of Paediatric Research, Division for Women and Children, Oslo University Hospital, Norway
| | - Dag S Thelle
- Medical Faculty, Institute of Basic Medical Sciences, University of Oslo, Norway.,Department of Community Medicine and Public Health, University of Gothenburg, Sweden
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Poor oral health and risk of incident myocardial infarction: A prospective cohort study of Swedish adults, 1973-2012. Sci Rep 2018; 8:11479. [PMID: 30065312 PMCID: PMC6068156 DOI: 10.1038/s41598-018-29697-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 07/11/2018] [Indexed: 12/31/2022] Open
Abstract
Previous studies provide conflicting evidence as to whether there is an association between poor oral health and an increased risk of myocardial infarction. The aim of the study was to deepen knowledge of the association between oral health and myocardial infarction risk using a large (n = 20,133), prospective, and population-based cohort in Uppsala, Sweden. Oral health was determined during a clinical dental examination at entry into the cohort in 1973/74. Individuals were followed through linkage with the Swedish National Patient Register, Cause of Death Register and Emigration Register. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) for total, non-fatal and fatal myocardial infarction events. Increased risks of total, non-fatal and fatal myocardial infarction events among individuals with fewer reference teeth at examination, more dental plaque and a borderline significant increased risk among individuals with oral lesions were observed. Adjustment for multiple potential confounding factors did not change the results appreciably. However, the observed HRs generally decreased towards one when the analysis was confined to non-tobacco users only. The results from this study indicate that poor oral health is associated with a slightly increased risk of myocardial infarction; however, these results may be partly explained by residual confounding.
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Yu YH, Doucette-Stamm L, Rogus J, Moss K, Zee RYL, Steffensen B, Ridker PM, Buring JE, Offenbacher S, Kornman K, Chasman DI. Family History of MI, Smoking, and Risk of Periodontal Disease. J Dent Res 2018; 97:1106-1113. [PMID: 29928831 DOI: 10.1177/0022034518782189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Periodontal disease (PD) shares common risk factors with cardiovascular disease. Our hypothesis was that having a family history of myocardial infarction (FamHxMI) may be a novel risk factor for PD. Risk assessment based on FamHxMI, conditional on smoking status, was examined given the strong influence of smoking on PD. Exploratory analysis with inflammatory biomarkers and genetic determinants was conducted to understand potential mechanistic links. The Women's Genome Health Study (WGHS) is a prospective cohort of US female health care professionals who provided blood samples at baseline in the Women's Health Study, a 2 × 2 factorial clinical trial investigating vitamin E and aspirin in the prevention of cardiovascular disease and cancer. PD was ascertained via self-report over 12 y of follow-up. Prevalence (3,442 cases), incidence (1,365 cases), and survival analysis of PD were investigated for associations of FamHxMI as well as in strata of FamHxMI by smoking. Kruskal-Wallis, chi-square tests, multivariate regression, and Cox proportional hazard models were used for the analyses. In the WGHS, women with FamHxMI showed higher risk of ever having PD. A particularly high-risk group of having both FamHxMI and smoking at baseline was highlighted in the prevalence and risk of developing PD. PD risk increased according to the following strata: no FamHxMI and nonsmokers (reference), FamHxMI and nonsmokers (hazard ratio [HR] = 1.2, 95% CI = 1.0 to 1.5), smokers without FamHxMI (HR = 1.3, 95% CI = 1.2 to 1.5), and smokers with FamHxMI (HR = 1.5, 95% CI = 1.2 to 1.8). An independent analysis by the dental Atherosclerosis Risk in Communities study ( N = 5,552) identified more severe periodontitis cases among participants in the high-risk group (smokers with FamHxMI). Further examination of interactions among inflammatory biomarkers or genetic exploration with FamHxMI did not explain the risk increase of PD associated with FamHxMI in the WGHS. Future efforts based on an integrative-omics approach may facilitate validation of these findings and suggest a mechanistic link between PD and FamHxMI.
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Affiliation(s)
- Y H Yu
- 1 Department of Periodontology, School of Dental Medicine, Tufts University, Boston, MA, USA.,2 Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - J Rogus
- 3 Interleukin Genetics, Waltham, MA, USA
| | - K Moss
- 4 Department of Periodontology, University of North Carolina, Chapel Hill, NC, USA
| | - R Y L Zee
- 2 Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,5 Department of Pediatric Dentistry, School of Dental Medicine, Tufts University, Boston, MA, USA
| | - B Steffensen
- 1 Department of Periodontology, School of Dental Medicine, Tufts University, Boston, MA, USA
| | - P M Ridker
- 2 Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - J E Buring
- 2 Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - S Offenbacher
- 4 Department of Periodontology, University of North Carolina, Chapel Hill, NC, USA
| | - K Kornman
- 3 Interleukin Genetics, Waltham, MA, USA
| | - D I Chasman
- 2 Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Periodontal Diseases and Possible Future Cardiovascular Events, Are they Related? An Overview. JOURNAL OF PEDIATRICS REVIEW 2017. [DOI: 10.5812/jpr.11144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Aarabi G, Zeller T, Seedorf H, Reissmann D, Heydecke G, Schaefer A, Seedorf U. Genetic Susceptibility Contributing to Periodontal and Cardiovascular Disease. J Dent Res 2017; 96:610-617. [DOI: 10.1177/0022034517699786] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Periodontal disease (PD) and coronary artery disease (CAD) are common diseases characterized by an overaggressive inflammatory response to diverse stimuli. Whereas PD leads to destruction of the tooth-supporting structures, CAD is a chronic inflammatory condition ultimately causing myocardial infarction via narrowing and occluding of blood vessels. Classical twin studies led to the conclusion that both complex diseases have a similar degree of heritability and that a significant fraction of the genetic factors accounting for this heritability is shared. Recent genome-wide association and large-scale candidate gene studies highlight that variations in >50 genes are associated with premature CAD, while variations in only 4 genes showing nominally significant associations with aggressive periodontitis and/or chronic periodontitis have so far been identified. Remarkably, 3 of the PD loci (75%) show shared associations with CAD ( ANRIL/CDKN2B-AS1, PLG, CAMTA1/VAMP3), suggesting involvement of common pathogenic mechanisms. In this critical review, we highlight recent progress in identifying genetic markers and variants associated with PD, present their overlap with CAD, and discuss functional aspects. In addition, we answer why a significant fraction of the heritability of PD is still missing, and we suggest approaches that may be taken to close the gap.
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Affiliation(s)
- G. Aarabi
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T. Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung, Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - H. Seedorf
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D.R. Reissmann
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G. Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A.S. Schaefer
- Department of Periodontology and Synoptic Dentistry, Center of Dento-Maxillo-Facial Medicine, Charité–Universitätsmedizin Berlin, Research Center ImmunoSciences, Berlin, Germany
| | - U. Seedorf
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Joshy G, Arora M, Korda RJ, Chalmers J, Banks E. Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630 participants from the prospective 45 and Up Study. BMJ Open 2016; 6:e012386. [PMID: 27577588 PMCID: PMC5013478 DOI: 10.1136/bmjopen-2016-012386] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/23/2016] [Accepted: 08/05/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To investigate the relationship between oral health and incident hospitalisation for ischaemic heart disease (IHD), heart failure (HF), ischaemic stroke and peripheral vascular disease (PVD) and all-cause mortality. DESIGN Prospective population-based study of Australian men and women aged 45 years or older, who were recruited to the 45 and Up Study between January 2006 and April 2009; baseline questionnaire data were linked to hospitalisations and deaths up to December 2011. Study exposures include tooth loss and self-rated health of teeth and gums at baseline. SETTING New South Wales, Australia. PARTICIPANTS Individuals aged 45-75 years, excluding those with a history of cancer/cardiovascular disease (CVD) at baseline; n=172 630. PRIMARY OUTCOMES Incident hospitalisation for IHD, HF, ischaemic stroke and PVD and all-cause mortality. RESULTS During a median follow-up of 3.9 years, 3239 incident hospitalisations for IHD, 212 for HF, 283 for ischaemic stroke and 359 for PVD, and 1908 deaths, were observed. Cox proportional hazards models examined the relationship between oral health indicators and incident hospitalisation for CVD and all-cause mortality, adjusting for potential confounding factors. All-cause mortality and incident CVD hospitalisation risk increased significantly with increasing tooth loss for all outcomes except ischaemic stroke (ptrend<0.05). In those reporting no teeth versus ≥20 teeth left, risks were increased for HF (HR, 95% CI 1.97, 1.27 to 3.07), PVD (2.53, 1.81 to 3.52) and all-cause mortality (1.60, 1.37 to 1.87). The risk of IHD, PVD and all-cause mortality (but not HF or ischaemic stroke) increased significantly with worsening self-rated health of teeth and gums (ptrend<0.05). In those reporting poor versus very good health of teeth and gums, risks were increased for IHD (1.19, 1.03 to 1.38), PVD (1.66, 1.13 to 2.43) and all-cause mortality (1.76, 1.50 to 2.08). CONCLUSIONS Tooth loss and, to a lesser extent, self-rated health of teeth and gums, are markers for increased risk of IHD, PVD and all-cause mortality. Tooth loss is also a marker for increased risk of HF.
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Affiliation(s)
- Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Manish Arora
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
- Department of Preventive Medicine and the Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - John Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- The Sax Institute, Sydney, New South Wales, Australia
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Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Periodontol 2016; 84:S70-84. [PMID: 23631585 DOI: 10.1902/jop.2013.134008] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. METHODS Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. RESULTS Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease).All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. CONCLUSIONS There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events.
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Affiliation(s)
- Thomas Dietrich
- Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK
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Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Clin Periodontol 2016; 40 Suppl 14:S70-84. [PMID: 23627335 DOI: 10.1111/jcpe.12062] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 12/19/2012] [Accepted: 11/14/2012] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. METHODS Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. RESULTS Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease). All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. CONCLUSIONS There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events.
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Affiliation(s)
- Thomas Dietrich
- Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK
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25
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Sharma P, Dietrich T, Ferro CJ, Cockwell P, Chapple IL. Association between periodontitis and mortality in stages 3-5 chronic kidney disease: NHANES III and linked mortality study. J Clin Periodontol 2016; 43:104-13. [PMID: 26717883 PMCID: PMC5324563 DOI: 10.1111/jcpe.12502] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2015] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Periodontitis may add to the systemic inflammatory burden in individuals with chronic kidney disease (CKD), thereby contributing to an increased mortality rate. This study aimed to determine the association between periodontitis and mortality rate (all-cause and cardiovascular disease-related) in individuals with stage 3-5 CKD, hitherto referred to as "CKD". METHODS Survival analysis was carried out using the Third National Health and Nutrition Examination Survey (NHANES III) and linked mortality data. Cox proportional hazards regression was employed to assess the association between periodontitis and mortality, in individuals with CKD. This association was compared with the association between mortality and traditional risk factors in CKD mortality (diabetes, hypertension and smoking). RESULTS Of the 13,784 participants eligible for analysis in NHANES III, 861 (6%) had CKD. The median follow-up for this cohort was 14.3 years. Adjusting for confounders, the 10-year all-cause mortality rate for individuals with CKD increased from 32% (95% CI: 29-35%) to 41% (36-47%) with the addition of periodontitis. For diabetes, the 10-year all-cause mortality rate increased to 43% (38-49%). CONCLUSION There is a strong, association between periodontitis and increased mortality in individuals with CKD. Sources of chronic systemic inflammation (including periodontitis) may be important contributors to mortality in patients with CKD.
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Affiliation(s)
- Praveen Sharma
- Periodontal Research GroupSchool of DentistryUniversity of BirminghamBirminghamUK
| | - Thomas Dietrich
- Periodontal Research GroupSchool of DentistryUniversity of BirminghamBirminghamUK
| | - Charles J. Ferro
- Department of NephrologyUniversity Hospital BirminghamBirminghamUK
| | - Paul Cockwell
- Department of NephrologyUniversity Hospital BirminghamBirminghamUK
| | - Iain L.C. Chapple
- Periodontal Research GroupSchool of DentistryUniversity of BirminghamBirminghamUK
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Periodontal disease and risk of coronary heart disease: An updated meta-analysis of prospective cohort studies. Int J Cardiol 2015; 201:469-72. [PMID: 26313869 DOI: 10.1016/j.ijcard.2015.07.087] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 07/29/2015] [Indexed: 02/05/2023]
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Yu YH, Chasman DI, Buring JE, Rose L, Ridker PM. Cardiovascular risks associated with incident and prevalent periodontal disease. J Clin Periodontol 2015; 42:21-8. [PMID: 25385537 DOI: 10.1111/jcpe.12335] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 01/12/2023]
Abstract
AIM While prevalent periodontal disease associates with cardiovascular risk, little is known about how incident periodontal disease influences future vascular risk. We compared effects of incident versus prevalent periodontal disease in developing major cardiovascular diseases (CVD), myocardial infarction (MI), ischaemic stroke and total CVD. MATERIAL AND METHODS In a prospective cohort of 39,863 predominantly white women, age ≥45 years and free of cardiovascular disease at baseline were followed for an average of 15.7 years. Cox proportional hazard models with time-varying periodontal status [prevalent (18%), incident (7.3%) versus never (74.7%)] were used to assess future cardiovascular risks. RESULTS Incidence rates of all CVD outcomes were higher in women with prevalent or incident periodontal disease. For women with incident periodontal disease, risk factor adjusted hazard ratios (HRs) were 1.42 (95% CI, 1.14-1.77) for major CVD, 1.72 (1.25-2.38) for MI, 1.41 (1.02-1.95) for ischaemic stroke and 1.27 (1.06-1.52) for total CVD. For women with prevalent periodontal disease, adjusted HRs were 1.14 (1.00-1.31) for major CVD, 1.27 (1.04-1.56) for MI, 1.12 (0.91-1.37) for ischaemic stroke and 1.15 (1.03-1.28) for total CVD. CONCLUSION New cases of periodontal disease, not just those that are pre-existing, place women at significantly elevated risks for future cardiovascular events.
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Affiliation(s)
- Yau-Hua Yu
- Division of Periodontology, Department of Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
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Chrysanthakopoulos NA, Oikonomou AA, Chrysanthakopoulos PA. Associations between Periodontal Disease Parameters and Coronary Heart Disease in Greek Adults: A Cross-sectional Study. ACTA ACUST UNITED AC 2015. [DOI: 10.5005/jp-journals-10029-1087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
ABSTRACT
Aim
Several forms of periodontal disease have been associated with the development of coronary heart disease. The current retrospective study was conducted to investigate the possible relationship between periodontal disease parameters and defined coronary heart disease (CHD) in Greek adult patients.
Materials and methods
The study sample consisted of 880 individuals, 400 males and 480 females, aged 40 to 78 years. Data were collected by means of an interviewer administered questionnaire and an oral clinical examination. Statistical analysis of the questionnaire items was performed by using multiple regression analysis model in order to assess possible associations between coronary heart disease as dependent variable and epidemiological variables, biomarkers and periodontal disease parameters as independent variables.
Results
The occurrence of hypertension (OR = 0.01, 95% CI = 0.09-1.33), high level of triglycerides (OR = 0.08, 95% CI = 0.06-2.27) and total cholesterol (OR = 0.08, 95% CI = 0.07- 1.27), low level of high-density lipoprotein (OR = 0.12, 95% CI = 0.09-3.70) and smoking (OR = 1.83, 95% CI = 0.38-8.88) were significantly associated with the presence of coronary heart disease, whereas the periodontal parameters examined were not associated with the occurrence of it.
Conclusion
No associations were observed between periodontal disease parameters and defined coronary heart disease. However, the recorded associations strengthen the role of hypertension, lipids and smoking as causative risk factors of coronary heart disease.
How to cite this article
Chrysanthakopoulos NA, Oikonomou AA, Chrysanthakopoulos PA, Saini R. Associations between Periodontal Disease Parameters and Coronary Heart Disease in Greek Adults: A Cross-sectional Study. Int J Experiment Dent Sci 2015;4(1):4-10.
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Abstract
Background. The pathophysiology of cardiovascular disease (CVD) includes inflammation in the development of atherosclerosis and thrombosis. Increasing evidence supports oral infections, and in particular the common periodontal disease, to be associated with CVD development. Periodontal infection is present in populations worldwide and in the moderate to mild form in about 35% of populations according to the World Health Organization. Objective. This review of the literature aims to present cross evidence from medical research disciplines that explore how oral infections can contribute to increase the risk for CVDs and how treatment of oral infections can reduce the risk for CVDs. Design. Review article. Results. Long-term exposure to active nontreated infections of the oral cavity presents an opportunity for bacteria, bacterial products, and viruses to enter the circulation. Toxic bacterial products enter the circulation, affecting atherosclerosis, causing platelet adhesiveness that results in clot formation, and establishing cardiac vegetation. Pathological observations have identified oral bacteria in heart valves, aortic aneurysms, and arterial walls. Clinical intervention studies on periodontal disease reduce the risk level of serological predictors for CVDs. Conclusions. This paper presents evidence across medical research disciplines for oral infections to be considered as one of the risk factors for CVDs.
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Rasouli-Ghahroudi AA, Rokn AR, Khorsand A, Aghajani H, Amini A, Shamshiri AR, Rahimi H, Kabir A. Designing and standardizing a questionnaire for evaluating knowledge, attitude, and practice of Iranian adults with cardiovascular diseases about oral health. ARYA ATHEROSCLEROSIS 2013; 9:350-6. [PMID: 24575138 PMCID: PMC3933060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/16/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiovascular diseases are the most common cause of death in Iran. Moreover, periodontal diseases are very common in our country. In this study, we have designed a standardized questionnaire for evaluating knowledge, attitude, and practice (KAP) of Iranian adult patients with cardiovascular diseases about oral health. METHODS For designing and standardizing a self-administered questionnaire, we performed a cross-sectional pilot study on 51 cases with periodontal complaints. A dentist carried out the physical examination to determine oral health indicators. Twelve experts and ten lay people of the target population answered questions about validity. Cronbach's alpha, factor analysis, and Pearson correlation coefficients were used in the analysis. RESULTS The cases of this pilot study were middle aged, with moderate financial and health status, but low oral health and educational level. Debris score was correlated with all other physical exam findings except decay, missing, and filled (DMF). Reliability was 0.826 according to Cronbach's alpha score. Face validity was higher than 80%. Content validities of the whole of the questionnaire were 85.98% for clarity, 78.05% for relevancy, 85.16% for simplicity, and 82.32% for consistency of each question with the question set. Factor analysis showed that 15 components explain 74% of the total variance. CONCLUSION This questionnaire is culturally adjusted and appropriate for our community, valid and reliable, and sufficiently estimates the variance of the oral health status. It can be used as a standard tool in further studies in adult population of the Iranian middle aged patients with low level of education and moderate socioeconomic status.
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Affiliation(s)
- Amir Alireza Rasouli-Ghahroudi
- Assistant Professor, Dental Implants Research Center AND Department of Periodontics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Rokn
- Associate Professor, Dental Implants Research Center AND Department of Periodontics, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Khorsand
- Associate Professor, Department of Periodontics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hasan Aghajani
- Assistant Professor, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afshin Amini
- Assistant Professor, Imam Hossein Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Shamshiri
- Assistant Professor, Dental Research Center, Dentistry Research Institute AND Department of Community Oral Health, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Kabir
- PhD Candidate, Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences AND Center for Educational Research in Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Ali Kabir,
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Saft C, Andrich JE, Müller T, Becker J, Jackowski J. Oral and dental health in Huntington's disease - an observational study. BMC Neurol 2013; 13:114. [PMID: 24138900 PMCID: PMC3766132 DOI: 10.1186/1471-2377-13-114] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Only a few case reports and case series dealing with oral and dental health care are available in literature until now. The aim of the present pilot study was to determine the status of dental health in comparison to matched controls and to heighten the neurologists' and dentists' awareness of the oral aspects of the disease. METHODS 42 Huntington's disease (HD) participants were scored according to the Unified Huntington's Disease Rating Scale. The dental status was assessed by using the well established score for decayed, missing, and filled teeth (DMFT) and the dental plaque score (Silness-Loe plaque index). RESULTS Compared to controls HD participants showed significantly more decayed teeth and more plaques in both plaque indices. A higher motor impairment and a lower functional status of the patients lead to a worsening in dental status. CONCLUSION Possible reasons for our findings are discussed. Apart from local oral complications general complications may also occur. Thus, as a consequence, we would encourage patients, caregivers, neurologists, and the dentists to ensure regular preventive dental examinations and dental treatments of individuals with Huntington's disease even in the premanifest stage of this disease.
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Auerkari E, Suhartono A, Djamal N, Verisqa F, Suryandari DA, Kusdhany L, Masulili S, Talbot C. CRP and IL-1B Gene Polymorphisms and CRP in Blood in Periodontal Disease. Open Dent J 2013; 7:88-93. [PMID: 24009648 PMCID: PMC3758952 DOI: 10.2174/1874210601307010088] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 01/18/2023] Open
Abstract
Recent studies have suggested an association between periodontal disease (PD) and the systemic polygenic diseases such as cardiovascular disease (CVD). These are thought to be associated because of interrelated environmental, epigenetic, and genetic risk factors. The involved candidate genes include the IL-1B gene, encoding the pro-inflammatory cytokine IL-1β, and the CRP gene encoding the C-reactive protein (CRP), also a known marker of inflammation. However, as the details are not well known on the genetic variation influencing the risk factors, this work aimed to evaluate the distribution of selected polymorphisms of IL-1B and CRP genes, and serum CRP level, in comparison with the PD status. For this purpose, periodontal health was assessed, serum CRP levels measured and polymorphism status of IL-1B and CRP genes determined from samples of peripheral blood taken from 101 consenting Indonesian adult males. The results show that severe PD was significantly associated with age and smoking, as expected, but not with the polymorphisms of IL-1B or CRP (1444). However, a significantly lower fraction of subjects with normal periodontal health than subjects with PD showed the heterozygous type polymorphism of CRP (717). There was no significant difference in the fraction of cases with elevated serum CRP level between subjects with normal health and those with PD, and further study with a larger sample is recommended. The observed association between polymorphism of CRP (717) and periodontal health is suggested as a complementary indicator of the risk to PD for the Indonesian male population.
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Affiliation(s)
- Ei Auerkari
- Department of Oral Biology, Faculty of Dentistry, University of Indonesia, Jakarta Indonesia ; Centre for Ageing Studies, University of Indonesia, Jakarta Indonesia
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