Periodontitis as a Risk Factor in non-diabetic Patients with coronary artery disease
Introduction
Coronary artery disease (CAD) remains the principal cause of death in most countries, despite significant preventive and therapeutic advances. It has many known risk factors like, Hypertension, Hyperlipidemia, Diabetes mellitus, Positive Family history, Smoking and so on. But many conditions increase risk of CAD yet, through atherosclerosis (1,3).
Recent studies illustrate the existence of a relation between periodontal disorders and coronary artery disease, which power the probable effect of periodontal disease as a risk factor for(CAD(4 and 5).Otherwise another were experienced insignificant relation between (CAD) and periodentitis(8-10). Periodontitis is associated with endotoxemia, leakage of lipopolysaccharides ( LPS )deriving from periodontal pathogens into circulation(4,20). LPS is one of the potent stimulators of systemic inflammation and intima wall macrophage-derived foam cell formation, and therefore it is considered a proatherogenic compound,
through the response to increasing levels of acute phase proteins (CRP) (7, 8 and 9) .
Also recent epidemiologic studies show that high CRP as a risk factor is considered for cardiovascular events (10). Also, an intervention study statement on whether the treatment of gingival inflammation (periodentitis) leads to reduced CHD mortality is not done (6).
Patients and Methods
A cohort study was done on 152 patients referring to Mazandaran Heart Center in North of Iran between 2008-2009. Inclusion criteria: Age over the 40 years who’s Coronary artery disease as defined by previous or current detection of 50% stenosis of a main coronary artery by coronary angiography .Or no significant stenosis of coronary artery.
Exclusion criteria: Diabetic, Periodontal treatment and/or antibiotic therapy during the last 6 months, Pregnancy, Current alcohol or drug abuse, or psychological reasons that make study participation impractical
Drugs which are potential causal for gingival hyperplasia such as (Hydantoin, Nifedipine, Cyclosporin A, and other)
The people studied divided in two groups by coronary angiography results.. Demographic information were derived from questions asked during the interviewed to age, sex, literacy level, weight, LDL and HDL, exercise, , smoking, blood pressure for all the two groups. Then a periodontal examination was done (by general dentist and periodontitis) for all participants of the study, who was unaware from the result of patient’s angiography.
Coronary artery disease defined by stenosis more than 50% lumen in at least one coronary artery in angiography .Periodontal disease is an inflammatory disease of tissues or teeth holder tissue that gradually causes the destruction of tissues and loss of teeth.
Clinical periodontal examination included measuring plaque (plaque terms), bleeding on examination with the probe (Barnett bleeding indexes), Probing packet depth at the mesial , distal, Bucal, Palatal or Lingual surface of all teeth except the third molar has been done
and CAL (Clinical Attachment Level) was calculated.
Plaques were recorded according to Silness & loe index. Plaque depth measuring, the entrance depth of probe in longitudinal axis of tooth and also CAL as mm is registered and the number of teeth remaining were recorded.
Plaque index (Silness & loe): accumulation of debries in gingival margins of tooth that is determined with the scale of 0 to 3.
0 = No plaque
1 =A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque may be observed in situ only after application of a disclosing solution or by using a probe on the tooth surface.
2 = moderate accumulation of soft deposits within gingival pocket, or on the tooth and gingival margin, that can be seen with the naked eye.
3 = an abundance of soft matter within the gingival pocket, on the tooth and gingival margin, in all these areas.
Modified papillary Bleeding Index (Barnett) bleeding after the probing of gums sulcus bleeding gums, diffuse marginal inflammation, and swollen red papillae is determined with the Scale of zero to 3 :
Zero: the lack of bleeding after 30 seconds
One: bleeding after 30 seconds
Two: bleeding 2 to 30 seconds
Three: bleeding less than 2 seconds
Gingival groove depth: Shallow crevice or space around the tooth bounded by the surface of the tooth on one side and the epithelium lining the free margin of the gingiva on the other, V shaped. Sulcus depth can be measured by a periodontal probe.Histologic depth is about 1.8mm,probing depth is2-3 mm.
Table 1 – distribution of people with coronary heart disease and without coronary heart disease according to gender
CHD
Gender
Patients With CHD (percent)
Patients Without CHD(percent)
Total
Male
37
(44.6)
46
(55.4)
83
Women
39
(56.5)
30
(43.5)
69
Illiterate or elementary
51
(67.1)
25
(32.9)
76
Guidance school
10
(43.5)
13
(56.5)
23
High School
11
(44)
14
(56)
25
Higher diploma
4
(14.3)
24
(85.7)
28
Clinical Attachment Level: The amount of space between attached periodontal tissues and a fixed point, usually the cement enamel junction.
A measurement used to assess the stability of attachment as part of a periodontal maintenance program.
Statistical significance was set at 0.05, and the unit of analysiswas the person.. Bivariate relationships were assessed by t tests or Kolmogorov-Smirnovtests for continuous variables and Cochran Mantel-Haenszel 2 statistics and odds ratios and 95% CIs for categoricalvariables.. Potential confounders were basedon the literature and our previous findings on the relationshipbetween clinical periodontal disease and CAD. (13-20).
Result
152 patients were included in this study.
There were 54.6% (83)men and the 45.4% (69) were female. The mean age for case group was 51.1+/-7.3(mean+/-SD) and 51.3+/-10.3 years for
control group. In male participants, 37 patients (44.6%) had coronary artery disease and among women 39 cases (56.5%) had CAD, which sex difference was not significant (p= 0.96) (Table 1).
The level of education and physical activity , has contrary effect on CAD and this difference was statistically significant (p <0.05). (Table 2,)
Table 6 – distribution of people with coronary heart disease and coronary heart disease based on GI.
CHD
GI
Number of people
With CHD (percent)
Number of people
Without CHD
(percent)
Total
Score 0
0
(0)
13
(100)
13
Score 1
5
(19.2)
21
(80.8)
26
Score 2
31
(55.4)
25
(44.6)
56
Score 3
40
(70.2)
17
(29.8)
57
Other risk factors comparable hypertension, hyperlipidemia, and smoking were higher significantly in CAD group than the other group one (p <0.05) (table 3,4,5).The level of physical activity in patients with CAD is significant less than other group.(table 2)
Mean BMI in patients without coronary artery disease is 25.72±2.95 and the mean BMI in people with CAD are30.29±5.34 that this relationship is statistically significant (P <0.05) .
Table 2 – Distribution of people with coronary heart disease and without coronary heart disease according to sport
CHD
Exercise
Number of people
With CHD (percent)
Number of people
Without CHD
(percent)
Total
Loss of
Physical
Activity
66
(73.3)
24
(26.7)
90
Regular exercise
1
(3)
32
(97)
33
Irregular exercise
9
(31)
20
(69)
29
Table 3 – distribution of people with coronary heart disease without coronary heart disease by smoking
CHD
Cigarettes
Patients With CHD (percent)
Patients Without
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