Porphyromonas gingivalis antibody levels and diagnosis of coronary artery disease in HIV-positive individuals

Is there evidence that periodontal diseases are risk factors for coronary arterial disease?-Scoping review

AIM

To determine the scientific evidence regarding the condition of periodontal diseases (PDs) as risk factors of coronary artery diseases.

MATERIALS AND METHODS

A scoping review was performed through the selection of articles from online databases (Medline via PubMed, LILACS, and Cochrane CENTRAL), using a search algorithm and eligibility criteria for data extraction and data synthesis of included papers. Four hundred forty-one studies from online databases and 1364 from reference lists were initially identified, and 34 articles were selected for inclusion. Articles had to be published between 2015 and 2020 and had to associate PDs to coronary arterial diseases. All studies comprised a sample of 446443 participants. Favorable opinions totaled 70.59%, and the cross-sectional observational study design was more frequently found (32.35%). Biochemical outcomes were showed more frequently, such as inflammatory biomarkers (58.82%). Despite a large advantage for favorable opinions, a statistically significant result was not found when extracted data were combined with studies opinions.

CONCLUSION

The evidence was classified as level II-3, hence, still distant from the best ranks and can therefore be considered as unclear. Moreover, studies with the higher potential to generate evidence showed a high risk of bias.

Mediators between oral dysbiosis and cardiovascular diseases

Clinical periodontitis is associated with an increased risk for cardiovascular diseases (CVDs) through systemic inflammation as the etiopathogenic link. Whether the oral microbiota, especially its quality, quantity, serology, and virulence factors, plays a role in atherogenesis is not clarified. Patients with periodontitis are exposed to bacteria and their products, which have access to the circulation directly through inflamed oral tissues and indirectly (via saliva) through the gastrointestinal tract, resulting in systemic inflammatory and immunologic responses. Periodontitis is associated with persistent endotoxemia, which has been identified as a notable cardiometabolic risk factor. The serology of bacterial biomarkers for oral dysbiosis is associated with an increased risk for subclinical atherosclerosis, prevalent and future coronary artery disease, and incident and recurrent stroke. In addition to species-specific antibodies, the immunologic response includes persistent, cross-reactive, proatherogenic antibodies against host-derived antigens. Periodontitis may affect lipoprotein metabolism at all levels, and all lipoprotein classes are affected. Periodontitis or its bacterial signatures may be involved not only in increased storage of proatherogenic lipids but also in attenuation of the anti-atherogenic processes, thereby putatively increasing the net risk of atherosclerosis. In this review we summarize possible molecular mediators between the dysbiotic oral microbiota and atherosclerotic processes.