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The Links Between Heart Attacks, Strokes, Diabetes and Periodontal Disease.

April 27, 2011
  1. Chronic Periodontitis as a Risk Factor for Acute Myocardial Infarction. [The relationship between periodontal disease and acute myocardial infarct has been investigated, but without conclusive results. Objective: To estimate the magnitude of the risk of acute myocardial infarct among patients with periodontal disease. Method: A case-control study was conducted in the city of Salvador, Brazil. A total of 621 subjects, 207 cases, 207 hospital controls and 207 community controls were selected. The cases with proven clinical and laboratory diagnoses of a first acute myocardial infarct event and controls without any history of acute myocardial infarct were matched according to sex and age. All the cases and controls underwent: a) complete periodontal examination; b) lipid and blood glucose profile tests; c) weight, height and hip and waist circumference measurements; d) questionnaire on sociodemographic and lifestyle habit conditions. The chi-square test was used in the descriptive analysis to compare proportions. To estimate the association, multivariate conditional logistic regression was used, and odds ratio measurements adjusted according to a series of potential confounders were obtained. Results: Among the individuals with periodontal disease, the chance of presenting acute myocardial infarct was greater than among those without periodontal disease, both for the community controls (ORcrude = 1.57; 95% CI [0.98-2.52]) and for the hospital controls (ORcrude = 1.73; 95% CI [1.11-2.72]). After adjustment for age, sex, smoking habit, schooling level and blood glucose level, this chance increased for both groups: community controls (ORadjusted = 1.89; 95% CI [1.11-3.28]) and hospital controls (ORadjusted = 1.92; 95% CI [1.14-3.23]). The fraction of the risk of acute myocardial infarct attributable to periodontal disease was around 12%. Conclusions: The findings from this study indicate that periodontal disease contributed independently to an important proportion of the occurrences of acute myocardial infarct in the study population.] Coelho J, Passos J, et al. IADR General Session, San Diego, CA March 2011.
  2. Periodontal Disease and Ischemic Stroke in Women. [Background: Previous studies have suggested an association between periodontitis and ischemic stroke, but very few have been conducted among women. Objective: To evaluate the relation between radiographically measured periodontal bone loss and the risk of ischemic stroke. Methods: We conducted a nested case-control study within the ongoing prospective cohort of U.S. female nurses (Nurses’ Health Study). Among women who provided blood samples in 1989-1990, after excluding those who had myocardial infarction prior to the stroke diagnosis, we included all 483 confirmed incident ischemic stroke cases that occurred between 1989 and 2006. Each case was individually matched with one eligible control by age, smoking, race, date of blood draw, fasting, menopause status, post-menopausal hormone use at blood collection, and availability of second blood sample from 2000. We requested pre-existing dental radiographs from all eligible 335 live cases and 393 controls, and evaluated periodontal bone loss on posterior teeth. Logistic regression models were used to evaluate the association between periodontal disease and incident ischemic stroke. Results: 186 participants (82 cases and 104 controls) provided dental radiographs dated prior to the stroke case diagnosis and the corresponding date for the controls. After adjusting for the matching factors, baseline diabetes, hypertension, BMI, alcohol and physical activity, being in the upper tertile of percent of sites with bone loss ≥2 mm was associated with a RR of 3.05 for ischemic stroke (95%CI: 1.29-7.22). There was no significant association between percentage of sites with bone loss ≥3mm (RR for 10% increment=0.96, 95%CI: 0.84-1.10), or severe periodontitis (≥1 site of ≥5mm) and ischemic stroke (RR=0.49, 95%CI: 0.24-1.01). Conclusions: Generalized periodontal bone loss seems to be associated with increased risk of ischemic stroke in this cohort. However, we did not observe a dose-response between periodontal bone loss severity and ischemic stroke risk.] Rexrode K, Lugo F, et al.IADR General Session, San Diego CA, March 2011.
  3. Positron Emission Tomography Measurement of Periodontal 18F-Fluorodeoxyglucose Uptake Is Associated With Histologically Determined Carotid Plaque Inflammation.[Objectives: This study aimed to test the hypothesis that metabolic activity within periodontal tissue (a possible surrogate for periodontal inflammation) predicts inflammation in a remote atherosclerotic vessel, utilizing 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging. Background: Several lines of evidence establish periodontal disease as animportant risk factor for atherosclerosis. FDG-PET imaging is an established method for measuring metabolic activity in human tissues and blood vessels. Methods: One hundred twelve patients underwent FDG-PET imaging 92 ± 5 min after FDG administration (13 to 25 mCi). Periodontal FDG uptake was measured by obtaining standardized uptake values from the periodontal tissue of each patient, and the ratio of periodontal to background (blood) activity was determined (TBR). Standardized uptake value measurements were obtained in the carotid and aorta as well as in a venous structure. Localization of periodontal, carotid, and aortic activity was facilitated by PET coregistration with computed tomography or magnetic resonance imaging. A subset of 16 patients underwent carotid endarterectomy within 1 month of PET imaging, during which atherosclerotic plaques were removed and subsequently stained with anti-CD68 antibodies to quantify macrophage infiltration. Periodontal FDG uptake was compared with carotid plaque macrophage infiltration. Results: Periodontal FDG uptake (TBR) is associated with carotid TBR(R = 0.64, p < 0.0001), as well as aortic TBR (R = 0.38; p = 0.029). Moreover, a strong relationship was observed between periodontal TBR and histologically assessed inflammation within excised carotid artery plaques (R = 0.81, p < 0.001). Conclusions: FDG-PET measurements of metabolic activity within periodontal tissue correlate with macrophage infiltration within carotid plaques. These findings provide direct evidence for an associationbetween periodontal disease and atherosclerotic inflammation.] Fifer KM, Qadir S, et al. J Am Coll Cardiol, 2011; 57:971-976, doi:10.1016/j.jacc.2010.09.056.
  4. Relationship between periodontal disease and diabetes mellitus: an Asian perspective.[Physicians and dentists have restricted themselves to their own respective fields in the past, only treating diseases that are relevant to their own fields of specialization. However, recent findings indicate that oral health may influence systemic health, and that this may influence systemic health, and that this maybe a bi-directional relationship in some conditions. This is particularly true for the relationship between periodontal disease and diabetes mellitus. The inter-relationship between periodontal disease and diabetes mellitus provides an example of a cyclical association, whereby a systemic disease predisposes the individual to oral infections, and, once the oral infection is established, it exacerbates the systemic disease. There are also associations between periodontal disease and systemic conditions such as cardiovascular problems, pulmonary conditions, osteoporosis, obesity, pancreatic cancer and Alzherimer’s disease. Hence, emphasis should now be placed on treating periodontal and other chronic dental diseases as a means of ameliorating systemic diseases.] Taiyeb-Ali, TB, Renukanth P, et al.Periodontology 2000, vol 56, issue 1 pp 258-268, June 2011.
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