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Carra MC, Rangé H, Caligiuri G, Bouchard P. Periodontitis and atherosclerotic cardiovascular disease: A critical appraisal. Periodontol 2000 2023. [PMID: 37997210 DOI: 10.1111/prd.12528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/12/2023] [Indexed: 11/25/2023]
Abstract
In spite of intensive research efforts driving spectacular advances in terms of prevention and treatments, cardiovascular diseases (CVDs) remain a leading health burden, accounting for 32% of all deaths (World Health Organization. "Cardiovascular Diseases (CVDs)." WHO, February 1, 2017, https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)). Cardiovascular diseases are a group of disorders affecting the heart and blood vessels. They encompass a collection of different conditions, among which atherosclerotic cardiovascular disease (ASCVD) is the most prevalent. CVDs caused by atherosclerosis, that is, ASCVD, are particularly fatal: with heart attack and stroke being together the most prevalent cause of death in the world. To reduce the health burden represented by ASCVD, it is urgent to identify the nature of the "residual risk," beyond the established risk factors (e.g., hypertension) and behavioral factors already maximally targeted by drugs and public health campaigns. Remarkably, periodontitis is increasingly recognized as an independent cardiovascular risk factor.
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Affiliation(s)
- Maria Clotilde Carra
- UFR d'Odontologie, Université Paris Cité, Paris, France
- Service of Odontology, Periodontal and Oral Surgery Unit, Rothschild Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- INSERM- Sorbonne Paris Cité Epidemiology and Statistics Research Centre (CRESS), Paris, France
| | - Hélène Rangé
- UFR d'Odontologie, Université de Rennes, Rennes, France
- Service of Odontology, Centre Hospitalier Universitaire de Rennes, Rennes, France
- NUMECAN Institute (Nutrition Metabolisms and Cancer), INSERM, INRAE, University of Rennes, Rennes, France
| | - Giuseppina Caligiuri
- Université Paris Cité and Université Sorbonne Paris Nord, INSERM, Laboratory for Vascular Translational Science (LVTS), Paris, France
- Department of Cardiology and of Physiology, Hôpitaux Universitaires Paris Nord Val-de-Seine, Site Bichat, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Philippe Bouchard
- UFR d'Odontologie, Université Paris Cité, Paris, France
- URP 2496, Université Paris Cité, Paris, France
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Empana JP, Lerner I, Perier MC, Guibout C, Jabre P, Bailly K, Andrieu M, Climie R, van Sloten T, Vedie B, Geromin D, Marijon E, Thomas F, Danchin N, Boutouyrie P, Jouven X. Ultrasensitive Troponin I and Incident Cardiovascular Disease. Arterioscler Thromb Vasc Biol 2022; 42:1471-1481. [PMID: 36325900 DOI: 10.1161/atvbaha.122.317961] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To examine the association of ultrasensitive cTnI (cardiac troponin I) with incident cardiovascular disease events (CVDs) in the primary prevention setting. METHODS cTnI was analyzed in the baseline plasma (2008-2012) of CVD-free volunteers from the Paris Prospective Study III using a novel ultrasensitive immunoassay (Simoa Troponin-I 2.0 Kit, Quanterix, Lexington) with a limit of detection of 0.013 pg/mL. Incident CVD hospitalizations (coronary heart disease, stroke, cardiac arrhythmias, deep venous thrombosis or pulmonary embolism, heart failure, or arterial aneurysm) were validated by critical review of the hospital records. Hazard ratios were estimated per log-transformed SD increase of cTnI in Cox models using age as the time scale. RESULTS The study population includes 9503 participants (40% women) aged 59.6 (6.3) years. cTnI was detected in 99.6% of the participants (median value=0.63 pg/mL, interquartile range, 0.39-1.09). After a median follow-up of 8.34 years (interquartile range, 8.0-10.07), 516 participants suffered 612 events. In fully adjusted analysis, higher cTnI (per 1 SD increase of log cTnI) was significantly associated with CVD events combined (hazard ratio, 1.18 [1.08-1.30]). Among all single risk factors, cTnI had the highest discrimination capacity for incident CVD events (C index=0.6349). Adding log cTnI to the SCORE 2 (Systematic Coronary Risk Evaluation) risk improved moderately discriminatory capacity (C index 0.698 versus 0.685; bootstrapped C index difference: 0.0135 [95% CI, 0.0131-0.0138]), and reclassification of the participants (categorical net reclassification index, 0.0628 [95% CI, 0.023-0.102]). Findings were consistent using the US pooled cohort risk equation. CONCLUSIONS Ultrasensitive cTnI is an independent marker of CVD events in the primary prevention setting.
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Affiliation(s)
- Jean-Philippe Empana
- Université Paris Cité, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, France (J.-P.E., I.L., M.-C.P., C.G., P.J., R.C., T.v.S., E.M., X.J.)
| | - Ivan Lerner
- Université Paris Cité, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, France (J.-P.E., I.L., M.-C.P., C.G., P.J., R.C., T.v.S., E.M., X.J.)
| | - Marie-Cécile Perier
- Université Paris Cité, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, France (J.-P.E., I.L., M.-C.P., C.G., P.J., R.C., T.v.S., E.M., X.J.)
| | - Catherine Guibout
- Université Paris Cité, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, France (J.-P.E., I.L., M.-C.P., C.G., P.J., R.C., T.v.S., E.M., X.J.)
| | - Patricia Jabre
- Université Paris Cité, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, France (J.-P.E., I.L., M.-C.P., C.G., P.J., R.C., T.v.S., E.M., X.J.)
| | - Karine Bailly
- Université Paris Cité, INSERM U1016, Cochin Institute, Platform CYBIO, France (K.B., M.A.)
| | - Muriel Andrieu
- Université Paris Cité, INSERM U1016, Cochin Institute, Platform CYBIO, France (K.B., M.A.)
| | - Rachel Climie
- Université Paris Cité, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, France (J.-P.E., I.L., M.-C.P., C.G., P.J., R.C., T.v.S., E.M., X.J.).,Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia (R.C.).,Baker Heart and Diabetes Institute, Melbourne, Australia (R.C.)
| | - Thomas van Sloten
- Université Paris Cité, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, France (J.-P.E., I.L., M.-C.P., C.G., P.J., R.C., T.v.S., E.M., X.J.).,Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, the Netherlands (T.v.S.)
| | - Benoit Vedie
- AP-HP, Department of Biochemistry, Tissue and Blood Samples Biobank, Georges Pompidou European Hospital, Paris, France (B.V., D.G.)
| | - Daniela Geromin
- AP-HP, Department of Biochemistry, Tissue and Blood Samples Biobank, Georges Pompidou European Hospital, Paris, France (B.V., D.G.)
| | - Eloi Marijon
- Université Paris Cité, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, France (J.-P.E., I.L., M.-C.P., C.G., P.J., R.C., T.v.S., E.M., X.J.)
| | - Frederique Thomas
- Preventive and Clinical Investigation Center (IPC), Paris, France (F.T., N.D.)
| | - Nicolas Danchin
- Preventive and Clinical Investigation Center (IPC), Paris, France (F.T., N.D.)
| | - Pierre Boutouyrie
- Université Paris Cité, INSERM U970, Cellular, Molecular and Pathophysiological Mechanisms of Heart Failure, Paris, France (P.B.)
| | - Xavier Jouven
- Université Paris Cité, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, France (J.-P.E., I.L., M.-C.P., C.G., P.J., R.C., T.v.S., E.M., X.J.)
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Deraz O, Rangé H, Boutouyrie P, Chatzopoulou E, Asselin A, Guibout C, Van Sloten T, Bougouin W, Andrieu M, Vedié B, Thomas F, Danchin N, Jouven X, Bouchard P, Empana JP. Oral Condition and Incident Coronary Heart Disease: A Clustering Analysis. J Dent Res 2021; 101:526-533. [PMID: 34875909 DOI: 10.1177/00220345211052507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Poor oral health has been linked to coronary heart disease (CHD). Clustering clinical oral conditions routinely recorded in adults may identify their CHD risk profile. Participants from the Paris Prospective Study 3 received, between 2008 and 2012, a baseline routine full-mouth clinical examination and an extensive physical examination and were thereafter followed up every 2 y until September 2020. Three axes defined oral health conditions: 1) healthy, missing, filled, and decayed teeth; 2) masticatory capacity denoted by functional masticatory units; and 3) gingival inflammation and dental plaque. Hierarchical cluster analysis was performed with multivariate Cox proportional hazards regression models and adjusted for age, sex, smoking, body mass index, education, deprivation (EPICES score; Evaluation of Deprivation and Inequalities in Health Examination Centres), hypertension, type 2 diabetes, LDL and HDL serum cholesterol (low- and high-density lipoprotein), triglycerides, lipid-lowering medications, NT-proBNP and IL-6 serum level. A sample of 5,294 participants (age, 50 to 75 y; 37.10% women) were included in the study. Cluster analysis identified 3,688 (69.66%) participants with optimal oral health and preserved masticatory capacity (cluster 1), 1,356 (25.61%) with moderate oral health and moderately impaired masticatory capacity (cluster 2), and 250 (4.72%) with poor oral health and severely impaired masticatory capacity (cluster 3). After a median follow-up of 8.32 y (interquartile range, 8.00 to 10.05), 128 nonfatal incident CHD events occurred. As compared with cluster 1, the risk of CHD progressively increased from cluster 2 (hazard ratio, 1.45; 95% CI, 0.98 to 2.15) to cluster 3 (hazard ratio, 2.47; 95% CI, 1.34 to 4.57; P < 0.05 for trend). To conclude, middle-aged individuals with poor oral health and severely impaired masticatory capacity have more than twice the risk of incident CHD than those with optimal oral health and preserved masticatory capacity (ClinicalTrials.gov NCT00741728).
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Affiliation(s)
- O Deraz
- Université de Paris, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, Paris, France.,Université de Paris, UFR of Odontology, Department of Periodontology, Paris, France
| | - H Rangé
- Université de Paris, UFR of Odontology, Department of Periodontology, Paris, France.,AP-HP, Rothschild Hospital, Department of Odontology, Paris, France.,Université de Paris, URP 2496, Paris, France
| | - P Boutouyrie
- Université de Paris, INSERM U970, Cellular, Molecular and Pathophysiological Mechanisms of Heart Failure, Paris, France
| | - E Chatzopoulou
- Université de Paris, UFR of Odontology, Department of Periodontology, Paris, France.,AP-HP, Rothschild Hospital, Department of Odontology, Paris, France.,Université de Paris, URP 2496, Paris, France
| | - A Asselin
- Université de Paris, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, Paris, France
| | - C Guibout
- Université de Paris, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, Paris, France
| | - T Van Sloten
- Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht, The Netherlands
| | - W Bougouin
- Université de Paris, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, Paris, France
| | - M Andrieu
- Université de Paris, Cochin Institute, Platform CYBIO, INSERM U1016, Paris, France
| | - B Vedié
- AP-HP, Georges Pompidou European Hospital, Department of Biochemistry, Tissue and Blood Samples Biobank, Paris, France
| | - F Thomas
- Preventive and Clinical Investigation Center, Paris, France
| | - N Danchin
- Preventive and Clinical Investigation Center, Paris, France
| | - X Jouven
- Université de Paris, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, Paris, France.,AP-HP, Georges Pompidou European Hospital, Department of Cardiology, Paris, France
| | - P Bouchard
- Université de Paris, UFR of Odontology, Department of Periodontology, Paris, France.,AP-HP, Rothschild Hospital, Department of Odontology, Paris, France.,Université de Paris, URP 2496, Paris, France
| | - J P Empana
- Université de Paris, INSERM U970, Integrative Epidemiology of Cardiovascular Disease, Paris, France
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