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Abstract
Blood viscosity is increased by elevated concentrations of acute phase reactants and hypergammaglobulinemia in inflammation. These increase blood viscosity by increasing plasma viscosity and fostering erythrocyte aggregation. Blood viscosity is also increased by decreased erythrocyte deformability, as occurs in malaria. Increased blood viscosity contributes to the association of acute infections with myocardial infarction (MI), venous thrombosis, and venous thromboembolism. It also increases vascular resistance, which decreases tissue perfusion and activates stretch receptors in the left ventricle, thereby initiating the systemic vascular resistance response. This compensates for the increased vascular resistance by vasodilation, lowering hematocrit, and decreasing intravascular volume. This physiological response causes the anemias associated with malaria, chronic inflammation, and other chronic diseases. Since tissue perfusion is inversely proportional to blood viscosity, anemia may be beneficial as it increases tissue perfusion when erythrocyte aggregating factors or erythrocytes with decreased deformability are present in the blood.
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Affiliation(s)
- Gregory D Sloop
- Pathology, Idaho College of Osteopathic Medicine, Meridian, USA
| | - Quirijn De Mast
- Internal Medicine, Radboud University Medical Center, Nijmegan, NLD
| | - Gheorghe Pop
- Cardiology, Radboud University Medical Center, Nijmegen, NLD
| | | | - John A St Cyr
- Cardiac/Thoracic/Vascular Surgery, Jacqmar, Inc., Minneapolis, USA
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Lee H, Kim HL, Jin KN, Oh S, Han YS, Jung DU, Sim HY, Kim HS, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Association between dental health and obstructive coronary artery disease: an observational study. BMC Cardiovasc Disord 2019; 19:98. [PMID: 31029089 PMCID: PMC6487007 DOI: 10.1186/s12872-019-1080-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background The association between dental health and coronary artery disease (CAD) remains a topic of debate. This study aimed to investigate the association between dental health and obstructive CAD using multiple dental indices. Methods Eighty-eight patients (mean age: 65 years, 86% male) were prospectively enrolled before undergoing coronary CT angiography (n = 52) or invasive coronary angiography (n = 36). Obstructive CAD was defined as luminal stenosis of ≥50% for the left main coronary artery or ≥ 70% for the other epicardial coronary arteries. All patients underwent thorough dental examinations to evaluate 7 dental health indices, including the sum of decayed and filled teeth, the ratio of no restoration, the community periodontal index of treatment needs, clinical attachment loss, the total dental index, the panoramic topography index, and number of lost teeth. Results Forty patients (45.4%) had obstructive CAD. Among the 7 dental health indices, only the number of lost teeth was significantly associated with obstructive CAD, with patients who had obstructive CAD having significantly more lost teeth than patients without obstructive CAD (13.08 ± 10.4 vs. 5.44 ± 5.74, p < 0.001). The number of lost teeth was correlated with the number of obstructed coronary arteries (p < 0.001). Multiple binary logistic regression analysis revealed that having ≥10 lost teeth was independently associated with the presence of obstructive CAD (odds ratio: 8.02, 95% confidence interval: 1.80–35.64; p = 0.006). Conclusions Tooth loss was associated with the presence of obstructive CAD in patients undergoing coronary evaluation. Larger longitudinal studies are needed to determine whether there is a causal relationship between tooth loss and CAD.
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Affiliation(s)
- Ho Lee
- Section of Dentistry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea.
| | - Kwang Nam Jin
- Department of Radiology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Yoon-Sic Han
- Section of Dentistry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Da-Un Jung
- Section of Dentistry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hye-Young Sim
- Section of Dentistry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Hee-Sun Kim
- Section of Dentistry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea
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Kumar A, Rai A. Oral Health Status, Health Behaviour and Treatment Needs of Patients Undergoing Cardiovascular Surgery. Braz J Cardiovasc Surg 2019; 33:151-154. [PMID: 29898144 PMCID: PMC5985841 DOI: 10.21470/1678-9741-2017-0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/22/2017] [Indexed: 12/03/2022] Open
Abstract
Objective The aim of the present study was to assess the oral health status and
treatment needs of cardiovascular surgery patients. Second, the awareness of
cardiovascular surgery patients regarding the association between oral
health and heart disease was considered. Methods Assessment of oral health status, oral hygiene practices and treatment needs
of 106 hospitalized patients in preparation for cardiovascular surgery.
Patients were interviewed using a structured questionnaire designed for this
study and oral examination was carried out by a dentist. Results The oral hygiene practices of the study cohort were not up to the standard.
Patients' awareness of infective endocarditis was poor. Approximately 68%
patients experienced dental caries as decayed teeth or missing teeth due to
caries and filled teeth. The mean plaque index in the study group was 1.25.
In this study cohort, the mean probing depth of periodontal pockets was
5.7±1.3, whereas the mean number of teeth with periodontal pockets
> 6 mm was 0.5±0.9. A total of 84 (74.2%) of the patients required
dental treatment. Conclusion The principal finding in this study was that patients with heart disease had
poor oral health. This study also highlights the importance of better
interaction among all healthcare professionals to integrate oral health as
part of comprehensive inpatient healthcare.
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Affiliation(s)
- Ansul Kumar
- Rajendra Institute of Medical Sciences (RIMS) Ranchi, Jharkhand, India
| | - Arpita Rai
- Faculty of Dentistry, Jamia Millia Islamia, New Delhi, India
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Söder B, Meurman JH, Söder PÖ. Dental Calculus Links Statistically to Angina Pectoris: 26-Year Observational Study. PLoS One 2016; 11:e0157797. [PMID: 27336307 PMCID: PMC4919060 DOI: 10.1371/journal.pone.0157797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 06/03/2016] [Indexed: 11/18/2022] Open
Abstract
Objectives Dental infections, such as periodontitis, associate with atherosclerosis and its complications. We studied a cohort followed-up since 1985 for incidence of angina pectoris with the hypothesis that calculus accumulation, proxy for poor oral hygiene, links to this symptom. Methods In our Swedish prospective cohort study of 1676 randomly selected subjects followed-up for 26 years. In 1985 all subjects underwent clinical oral examination and answered a questionnaire assessing background variables such as socio-economic status and pack-years of smoking. By using data from the Center of Epidemiology, Swedish National Board of Health and Welfare, Sweden we analyzed the association of oral health parameters with the prevalence of in-hospital verified angina pectoris classified according to the WHO International Classification of Diseases, using descriptive statistics and logistic regression analysis. Results Of the 1676 subjects, 51 (28 women/23 men) had been diagnosed with angina pectoris at a mean age of 59.8 ± 2.9 years. No difference was observed in age and gender between patients with angina pectoris and subjects without. Neither was there any difference in education level and smoking habits (in pack years), Gingival index and Plaque index between the groups. Angina pectoris patients had significantly more often their first maxillary molar tooth extracted (d. 16) than the other subjects (p = 0.02). Patients also showed significantly higher dental calculus index values than the subjects without angina pectoris (p = 0.01). Multiple regression analysis showed odds ratio 2.21 (95% confidence interval 1.17–4.17) in the association between high calculus index and angina pectoris (p = 0.015). Conclusion Our study hypothesis was confirmed by showing for the first time that high dental calculus score indeed associated with the incidence of angina pectoris in this cohort study.
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Affiliation(s)
- Birgitta Söder
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
- * E-mail:
| | - Jukka H. Meurman
- Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Per-Östen Söder
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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Schjetlein AL, Jørgensen ME, Lauritzen T, Pedersen ML. Periodontal status among patients with diabetes in Nuuk, Greenland. Int J Circumpolar Health 2014; 73:26093. [PMID: 25498562 PMCID: PMC4265130 DOI: 10.3402/ijch.v73.26093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 10/30/2014] [Accepted: 11/01/2014] [Indexed: 01/30/2023] Open
Abstract
Background Diabetes is becoming more common in the Greenlandic population. Patients with diabetes are more prone to periodontal disease. Periodontal status may have an effect on metabolic control. Objective The aim of this study was to estimate the prevalence of periodontitis amongst patients with diabetes in Nuuk, Greenland, and secondly, to observe if dental care was associated with improved periodontal status and metabolic control. Study design Observational cross-sectional study and a pilot study of a dental care intervention. Methods Sixty-two Greenlandic patients with diabetes were included in the study. Data were collected from the Electronic Medical Records (EMR), in addition to a telephone interview. Patients were offered 3 dental examinations with a 3-month interval. The dental examinations consisted of a full-mouth assessment of number of remaining teeth and assessment of periodontal status. Patients received scaling and root planing, together with information and instructions on oral hygiene. Information on glycated haemoglobin (HbA1C) values was collected from the EMR at each dental examination. Results In this study, 21.0% (13/62) of patients with diabetes had periodontitis. About 42% had less than 20 teeth. The association between diabetes and periodontitis was known by 20 out of the 62 patients. Over half of the patients had been to a dental examination within the last year. The prevalence of periodontitis decreased significantly from 21.0 to 0% (p<0.001) after 3 dental examinations. No change in HbA1C levels was observed (p=0.440). Conclusion Periodontitis was common among patients with diabetes in Nuuk. Dental health status based on Periodontal Screening Index (PSI) and bleeding on probing (BOP) seemed to improve after dental health care, indicating a need for increased awareness among patients and health care professionals. HbA1C levels were not improved among the patients.
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Affiliation(s)
| | - Marit Eika Jørgensen
- Steno Diabetes Center, Gentofte, Denmark; Centre for Health Research in Greenland, Southern Denmark University, Odense, Denmark
| | - Torsten Lauritzen
- Section of General Practice, Department of Public Health, Aarhus University, Arhus, Denmark
| | - Michael Lynge Pedersen
- Queen Ingrid Health Care Centre, Nuuk, Greenland; Greenland Centre for Health Research, Institute of Nursing and Health Science, University of Greenland, Nuuk, Greenland
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