Cardiovascular Disease

By Elena Connolly

“For example, a case-control study found that men younger than 60 years who had severe periodontitis had a 4.3 times higher risk of experiencing stroke than did patients in the same age group who had mild or no periodontitis” JADA, Vol. 138 http://jada.ada.org September 2007 29S

Atherosclerosis is a condition that can lead to serious health conditions including heart attack or stroke. It is the result of the formation of plaques in the arterial walls. This formation is complex, and involves many underlying inflammatory molecules. If sufficiently advanced, blockages or reduced blood flow can lead to inadequate blood supply to a variety of organs. Coronary heart disease is the most common clinical syndrome of atherosclerosis, affecting over 17 million Americans as of a 2009 statistical update by the American Heart Association.

Cardiovascular diseases remain the number one cause of death in the United States. They account for over 2.45 million deaths, or 34.3% of all deaths, per year. The American Heart Association has estimated that 785,000 Americans will experience a heart attack in the year 2010. An additional 470,000 will experience a repeated episode, while another 195,000 will experience a first silent heart attack. About 610,000 new strokes will occur per year on top of 185,000 recurrent cases. Atherosclerosis is extremely prevalent in the US and also extremely dangerous.

The disease progresses from endothelial events at the microscopic level to full plaque development that can lead to growth and rupture. Inflammation plays an important role in atherosclerosis, and underlies the process of plaque formation. Acute inflammatory processes are also likely to be involved with plaque rupture.

As in diabetes, many biomarkers of inflammation have been lined to pro-inflammatory cytokines that stimulate nuclear factor-kappa-beta pathway. This leads to increased production of cellular adhesion molecules, which may correlate with risk of developing plaques.

Studies over the past two decades have shown a significant link between periodontal disease and atheromatous diseases. Meurman et al. reported a 20% higher risk for cardiovascular disease (CVD) among patients with periodontal disease and even higher risk for cerebrovascular disease.

A study of Finnish individuals was conducted that followed a population of 102 control subjects. A Dental Severity Index score was used to determine progression of periodontal disease. They found that those with signs of periodontal disease were 30% more likely to have myocardial infarction when compared to those without sign of oral infection. In a follow-up study, the same investigators found a significant link between dental infections and severe coronary atheromatosis in males.

Another study followed 1,147 males aged 21-80 who were free of coronary artery disease (CAD). They also were assessed for periodontal disease by analyzing percent of alveolar bone loss using dental radiographs. Over an 18-year period, 207 participants developed CAD, with 59 dying from CAD, and an additional 40 experiencing strokes. When graphing incidence of CAD with respect to periodontal disease, they discovered a linear relationship—increased severity of periodontitis was met with increasing occurrences of cardiovascular disease.

DeStefano et al. studied the same relationship with 9,760 adults who were followed over a 14-year period. Several related variables were accounted for including age, gender, race, blood pressure, cholesterol levels, etc. They found those who had periodontal disease were 25% more likely to develop CAD compared to those with minimal levels of the disease. Interestingly, males with periodontitis under the age of 50 were 72% more likely to develop CAD verses their counterparts.

A similar study by Wu et al. looked at the same population, but analyzed the relationship between periodontitis and strokes. They reported a two times higher risk of stroke when periodontal disease was present.

There is an obvious link between periodontal disease and Atherosclerosis. However, there is an equally important correlation between the introduction of dental treatment and subsequent decrease of risk. Several human intervention trials support this thesis. D’Auito et al. showed that those treated with scaling and root planning had a reduction in CVD biomarkers like CRP and interleukin-6.When patients showed a positive response to the oral health regimen, i.e. reduction of pocket depth, they were four times more likely to show decreases of CRP when compared to those who did not have such a response to treatment.

Aetna teamed up with Columbia University to analyze the relationship between periodontal disease and cardiovascular disease. The study inquired about the cause/effect relationship but also looked at the effect on health care costs. Their findings showed a significant drop in overall health costs in patients who had a regular oral health regime to the tune of 16% for those with coronary artery disease and 11% for those with cardiovascular disease.

There was also a significant finding in that, those had periodontal treatment had significantly less risk for developing chronic conditions like CAD and CVD. They found that patients who received dental treatment had a 19% lower risk for CAD and 17% lower risk for CVD.

The consensus among insurance companies and academics a like, is that oral health not only has a preventative effect on the development of cardiovascular disease, but also may alleviate risk once introduced to the patient’s routine.

 

ATHEROSCLEROSIS

Meurman JH, Sanz M, Janket SJ. Oral health, atherosclerosis and cardiovascular disease. Crit Rev Oral Biol Med 2004;15:403-413.

Matilla K, Nieminen M, Valtonen V, Rasi V, Kesaniemi Y, Syrjala S, Jungul P, Isoluoma M, Hietaniemi K, Jokinen M, Huttunen J. Association between dental health and acute myocardial infarction. Br Med J 1989;298:779-782.

Matilla KJ, Valle MS, Nieminen MS, Valtonen VV, Hietaniemi KL. Dental infections and coronary atherosclerosis. Atherosclerosis 1993;103:205-211.

Beck JD, Garcia R, Heiss G, Vokonas P, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol 1996;67:1123-1137.

DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. Br Med J 1993;306:688-691.

Wu T, Trevisan M, Genco RJ, Ralkner KL, Dorn JP, Sempos CT. An examination of the relation between periodontal health status and cardiovascular risk factors. Serum total and HDL cholesterol, C-reactive protein, and plasma fibrinogen. Am J Epidemiol 2000;85:180-189.

D’Aiuto F, Ready D, Tonetti MS. Periodontal disease and C-reactive protein-associated cardiovascular risk. J Periodontal Res 2004;39:236-241.