Is there a relationship between dental and/or periodontal pathology and values of C-reactive protein, Homocysteine and Lipoprotein (a) in patients with cardiovascular disease? A case control study
Abstract
Background
Dental pathology [dental caries (DC) and apical periodontitis (AP)] and/or periodontal pathology (PD) could influence the onset of cardiovascular disease (CVD). The relationship between conventional CVD risk factors and dento-periodontal pathology has been well demonstrated; however, there is less evidence of the relationship between these pathologies and emerging or unconventional CVD risk factors, including C-reactive protein (CRP), Homocysteine (Hcy) and Lipoprotein a (Lp (a).
Methods
This case-control study included 99 patients with CVD and 50 healthy controls. All participants underwent a detailed medical history, an intraoral examination, an orthopantomography and a blood test. All the analyses were performed on the data set, using all available information with intention to treat criteria.
Results
A greater number of patients in the study group presented PD (p <0.001) and AP (p <0.001) compared to the control group. However, we did not find significant differences in the prevalence of caries between both groups (p <0.287). Moreover, none of oral variables was significantly related to concentrations of CRP, Hcy or Lp(a).
Conclusions
Patients with CVD present more PD and a greater number of AP, suggesting an association between dento-periodontal pathology and cardiovascular pathology. The concentrations of CRP, homocysteine and Lp(a) are not related to the degree of dento-periodontal pathology, so we believe that more studies are necessary to assess this possible association.
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References
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26. Ersin Kallkan R, Öngöz Dede F, Gökmenoglu C, et al. Salivary fetuin-A, S100A12, and high sensitivity C-Reactive protein levels in periodontal diseases. Oral Dis. 2018 Nov;24(8):1554-61.
27. Keceli HG, Ercan N, Karsiyaka Hendek M, et al. The effect of the systemic folic acid intake as an adjunct to scaling and root planning on clinical parameters and homocysteine and C-reactive protein levels in gingival crevicular fluid of periodontitis patients: a randomized placebo-controlled clinical trial. J Clin Periodontol. 2020 Feb 28. doi: 10.1111/jcpe.13276. [Epub ahead of print].
28. Ridker PM, Hennekens CH, Buring JE, et al. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Eng J Med. 2000 Mar;342(12):836-43.
29. Meurman JH, Qvarnström M, Janket SJ, et al. Oral health and health behavior in patients referred for open-heart surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.. 2003 Mar;95(3):300-7.
30. Rydén L, Buhlin K, Ekstrand E, et al. Periodontitis increases the risk of first myocardial infarction: A report from the PAROKRANK Study. Circulation. 2016 Feb;133(6):576-83.
31. Baszczuk A, Kopczynski Z. Hyperhomocysteinemia in patients with cardiovascular disease. Postepy Hyg Med Dosw. 2014 Jan;68:579-89.
32. Bhardwai S, Prabhuji ML, Karthinkeyan BV. Effect of non-surgical periodontal therapy on plasma homocysteine levels in indian population with chronic periodontitis: a pilot study. J Clin Periodontol 2015 Mar;42(3):221-7.
33. Mallapragada S, Kasana J, Agrawal P. Effect of nonsurgical periodontal therapy on serum highly sensitive capsule reactive protein and homocysteine levels in chronic periodontitis: A pilot study. Contemp Clin Dent. 2017 Apr-Jun;8(2):279-85.
34. Tsimikas S, Brilakis ES, Miller ER, et al. Oxidazed phospholipids, Lp(a) lipoprotein, and coronary artery disease. N Eng J Med. 2005 Jul;353(1):46-57.
35. Banach M. Lipoprotein (a) – We Know so much yet still have much to learn… J Am Heart Assoc. 2016 Apr;5(4):e003597.
36. Tüter G, Kurtis B, Serdar M, et al. Effects of scaling and root planning and subantimicrobial dose soxycycline on oral and systemic biomarkers of disease in patients with both chronic periodontitis and coronary artery disease. J Clin Periodontol. 2007 Aug;34(8):673-81.
2. Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999 Dec;4(1):1-6.
3. Page RC, Eke PI. Case definitions for use in population-based surveillance of periodontitis. J Periodontol. 2007 Jul;78(7 Suppl):1387-99.
4. Segura-Egea JJ, Dominguez BS, Monroy CC. Medicina endodoncica: implicaciones sistémicas de la patologia y terapéutica endodoncicas. Endodoncia. 2010;28:233–40.
5. Benjamin EJ, Blaha MK, Chiuve SE, et al. Heart disease and stroke statistics – 2017 update: a report from the American heart association. Circulation. 2017 Mar;135(10):e146–e603.
6. European Heart Network, European cardiovascular disease statistics, Available online at: http://www.ehnheart.org/cvd-statistics/cvd-statistics-2017.html, (2017), Accessed date: 15 April 2019.
7. Peters SAE, Wang X, Lam TH, et al. Clustering of risk factors and the risk of incident cardiovascular disease in Asian and caucasian populations: results from the Asia Pacific cohort studies collaboration. BMJ Open. 2018 Mar;8(3):e019335.
8. Braunwald E. Shattuck lecture–cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. N Engl J Med. 1997 Nov; 337(19):1360–9.
9. Ross R. Atherosclerosis – An inflammatory disease. N Engl J Med 1999 Jan;340(2):115-26.
10. Bahls M, Lorenz MW, Dör M, et al. Progression of conventional cardiovascular risk factors and vascular disease risk in individuals: insights from the PROG-IMT consortium. Eur J Prev Cardiol. 2020 Feb;27(3):234-43.
11. Li Y, Shong X, Cheng G, et al. Hs-CRP and all cause, cardiovascular and cancer mortality risk: a meta-analysis. Atherosclerosis. 2017 Apr;259:75-82.
12. Boushey CJ, Beresford SA, Omenn GS, et al. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease: probable benefits of increasing folic acid intakes. JAMA. 1995 Oct;274(13):1049-57.
13. Tsimikas S, Hall JH. Lipoprotein (a) as a potencial causal genetic risk factor of cardiovascular disease: a rationale for increased efforts to understand its pathophsysiology and develop targeted therapies. J Am Coll Cardiol. 2012 Aug;60(8):716-21.
14. Chysant SG, Chrysant GS. The current status of homocysteine as a risk factor for cardiovascular disease: a mini review. Expert Rev Cardiovasc Ther 2018 Aug;16(8):599-65.
15. Saleheen D, Haycock PC, Zhao W, et al. Apolipoprotein (a) isoform size, lipoprotein (a), concentration, and coronary artery disease: a mendelian randomisation analysis. Lancet Diabetes Endocrinol 2017 Jul;5(7):524-33.
16. O’Donnell CJ, Elosua R. Cardiovascular risk factors. Insights from Framingham Heart Study. Rev Esp Cardiol. 2008 Mar;61(3):299-310.
17. Lacey B, Herrington WG, Preiss D, et al. The role of emerging risk factors in cardiovascular outcomes. Curr Atheroscler Rep. 2017 Jun;19(6):28.
18. Hu H, Wang C, Jin Y, et al. Catalpol inhibits homocysteine-induced oxidation and inflammation via inhibiting Nox4/NF-kB and GRP78/PERK pathways in human aorta endothelial cells. Inflammation. 2019 Feb;42(1):64-80.
19. Tsimikas S, Hall JH. A test in context: lipoprotein (a): diagnosis, prognosis, controversies, and emergin therapies. J Am Coll Cardiol. 2017 Feb;69(6):692-711.
20. Silness J, Löe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964 Feb;22:121-35.
21. Ainamo J, Barmes D, Beagrie G, et al. Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN). Int Dent J. 1982 Sep;32(3):281-91.
22. Klein H, Palmer CE, Knutson JW. Studies on dental caries I. Dental status and dental needs of elementary school. Public Health Report. 1938;53:751-65.
23. Örstavik D, Pitt Ford TR. The periapical index: a scoring system for radiographic assessment of apical periodontitis. Endod Dent Traumatol. 1986 Feb;2(1):20-34.
24. Wang J, Tan GJ, Han Ln, et al. Novel biomarkers for cardiovascular risk prediction. J Geriatr Cardiol. 2017 Feb;14(2):135-50.
25. Sezgin Y, Bulut S, Bozalioglu S, et al. Levels of high sensitivity C-reactive protein in heart transplant patients with and without periodontitis. Exp Clin Transplant. 2019 Jan;17(Suppl 1):123-7.
26. Ersin Kallkan R, Öngöz Dede F, Gökmenoglu C, et al. Salivary fetuin-A, S100A12, and high sensitivity C-Reactive protein levels in periodontal diseases. Oral Dis. 2018 Nov;24(8):1554-61.
27. Keceli HG, Ercan N, Karsiyaka Hendek M, et al. The effect of the systemic folic acid intake as an adjunct to scaling and root planning on clinical parameters and homocysteine and C-reactive protein levels in gingival crevicular fluid of periodontitis patients: a randomized placebo-controlled clinical trial. J Clin Periodontol. 2020 Feb 28. doi: 10.1111/jcpe.13276. [Epub ahead of print].
28. Ridker PM, Hennekens CH, Buring JE, et al. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Eng J Med. 2000 Mar;342(12):836-43.
29. Meurman JH, Qvarnström M, Janket SJ, et al. Oral health and health behavior in patients referred for open-heart surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod.. 2003 Mar;95(3):300-7.
30. Rydén L, Buhlin K, Ekstrand E, et al. Periodontitis increases the risk of first myocardial infarction: A report from the PAROKRANK Study. Circulation. 2016 Feb;133(6):576-83.
31. Baszczuk A, Kopczynski Z. Hyperhomocysteinemia in patients with cardiovascular disease. Postepy Hyg Med Dosw. 2014 Jan;68:579-89.
32. Bhardwai S, Prabhuji ML, Karthinkeyan BV. Effect of non-surgical periodontal therapy on plasma homocysteine levels in indian population with chronic periodontitis: a pilot study. J Clin Periodontol 2015 Mar;42(3):221-7.
33. Mallapragada S, Kasana J, Agrawal P. Effect of nonsurgical periodontal therapy on serum highly sensitive capsule reactive protein and homocysteine levels in chronic periodontitis: A pilot study. Contemp Clin Dent. 2017 Apr-Jun;8(2):279-85.
34. Tsimikas S, Brilakis ES, Miller ER, et al. Oxidazed phospholipids, Lp(a) lipoprotein, and coronary artery disease. N Eng J Med. 2005 Jul;353(1):46-57.
35. Banach M. Lipoprotein (a) – We Know so much yet still have much to learn… J Am Heart Assoc. 2016 Apr;5(4):e003597.
36. Tüter G, Kurtis B, Serdar M, et al. Effects of scaling and root planning and subantimicrobial dose soxycycline on oral and systemic biomarkers of disease in patients with both chronic periodontitis and coronary artery disease. J Clin Periodontol. 2007 Aug;34(8):673-81.
Authors
Gonzalez Navarro, B., Jané Salas, E., Lopez Lopez, J., & Pintó Sala, X. . (2020). Is there a relationship between dental and/or periodontal pathology and values of C-reactive protein, Homocysteine and Lipoprotein (a) in patients with cardiovascular disease? A case control study. Journal of Current Medical Research and Opinion, 3(05), 451–458. https://doi.org/10.15520/jcmro.v3i05.285
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