Dental infections and coronary atherosclerosis

doi:10.1016/0021-9150(93)90263-T

Atherosclerosis

Volume 103, Issue 2, November 1993, Pages 205-211

https://doi.org/10.1016/0021-9150(93)90263-T Get rights and content

Abstract

An association between dental and other bacterial infections and coronary heart disease has recently been observed in both cross-sectional and longitudinal studies. To elucidate this topic, the severity of dental infections and coronary atheromatosis was assessed, together with measurements of the conventional coronary risk factors, in 100 individuals (88 men, 12 women, mean age 48, range 28–68 years) referred for diagnostic coronary angiography. Pantomography X-rays and coronary angiograms of the participants were scored blindly by single observers, a dentist and a radiologist respectively. The median pantomography score was 3.0 in male individuals belonging to the highest tertile of coronary atheromatosis score, as compared with 0.0 among the rest of the male participants (P = 0.003). The association between dental infections and severe coronary atheromatosis in males remained significant after adjusting for the effect of age, blood lipids, body mass index, hypertension, smoking and social class. No association between dental infections and coronary atheromatosis was observed in the small number of females studied. This observation supports the proposal that bacterial infections play a role in the pathogenesis of coronary atherosclerosis.

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Citation Excerpt :
Periodontitis is a bacterially induced chronic inflammatory disease of tissues supporting the teeth and is highly prevalent (20–50%) in the adult population [1]. In the past decades, several epidemiological studies have suggested positive associations between clinically established periodontal and cardiovascular disease [2–4], and several small experimental studies have proposed potential mechanisms underlying these associations [2,5]. The mechanism that has been most advocated is bacteremia followed by vascular contamination by periodontal pathogens [2,6].
Previous studies have suggested positive associations between periodontal infection and cardiovascular disease. We aimed to investigate the associations of circulating antibodies against periodontal pathogens with 1-year cardiovascular outcome, as well as the extent of coronary atherosclerosis, plaque vulnerability and lesion remodeling on intravascular ultrasound (IVUS) imaging.
Between 2008 and 2011, radiofrequency IVUS imaging of a non-culprit coronary artery was performed in 581 patients who underwent coronary angiography. Immunoglobulin G (IgG) and A (IgA) against Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Tannerella forsythia and Prevotella intermedia were measured in plasma.
None of the antibody levels were associated with coronary plaque burden, radiofreqeuncy-IVUS-derived thin-cap fibroatheroma lesion morphology or 1-year incidence of major adverse cardiac events (MACE), which included all-cause mortality, acute coronary syndrome and unplanned coronary revascularization. IgA against A. actinomycetemcomitans, T. forsythia and P. intermedia were inversely associated with extent of positive lesion remodeling (OR for highest versus lowest tertile 0.55, 95%CI 0.35–0.88, p = 0.012; 0.53, 95%CI 0.32–0.87, p = 0.012; and 0.64, 95%CI 0.40–1.02, p = 0.061, respectively). In diabetic patients specifically, IgG against P. gingivalis tended to be associated with coronary plaque burden (p = 0.080), while IgA against P. gingivalis tended to be associated with incident MACE (p = 0.060).
Plasma IgG and IgA against major periodontal pathogens were not associated with the extent of coronary atherosclerosis (with the exception of a trend in diabetics) nor with coronary plaque vulnerability. IgA against periodontal pathogens were inversely associated with extent of coronary remodeling. Altogether, these results do not add evidence for a substantial role of systemic exposure to periodontal pathogens in coronary artery disease.
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Research paperDental infections and coronary atherosclerosis

Abstract

Lancet

Am. J. Cardiol.

Atherosclerosis

Am. Heart J.

Am. J. Med.

Atherosclerosis

Exp. Mol. Pathol.

Cell.

Thromb. Res.

Metabolism

Inflammation and the onset of acute myocardial infarction

Ann. Intern. Med.

Association between poor dental health and acute myocardial infarction

Br. Med. J.

Chronic Chlamydia pneumoniae infection as a risk factor for coronary heart disease in the Helsinki Heart Study

Ann. Intern. Med.

Dental disease and risk of coronary heart disease and mortality

Br. Med. J.

Preceding infection as an important risk factor for ischaemic brain infarction in young and middle aged patients

Br. Med. J.

Dental infections in association with cerebral infarction in young and middle aged men

J. Intern. Med.

Selective coronary arteriography: a percutaneous transfemoral technique

Radiology

Research paper
Dental infections and coronary atherosclerosis