Acute Coronary Syndrome in Patients With
Coexistent Periodontal Disease
RJuly 2004 (Vol. 75, No. 7)
Inflammatory Response to Acute Coronary Syndrome in Patients With
Coexistent Periodontal Disease
Maciej R. Czerniuk, Renata Górska, Krzysztof J. Filipiak,
and Grzegorz Opolski
Abstract
Background: The inflammatory process that occurs in atherosclerotic
plaque situated in the coronary vessel often leads to its destabilization,
which in turn results in clot formation and the occurrence of
acute coronary syndrome. Acute coronary syndromes (unstable angina,
myocardial infarction) are among the leading causes of death in
the human population. An inflammatory factor which leads to this
process may be bacterial pathogens originating in the periodontal
tissues. The aim of the study was to evaluate the influence of
periodontal disease on the intensity and dynamics of the inflammatory
response in patients with acute coronary syndrome and coexistent
periodontal diseases.
Methods: The study involved a group of 50 consecutive patients
(nine females; 41 males) ?60 years of age (37 to 60; mean 51)
with coronary pain and with an initial diagnosis of acute coronary
syndrome admitted to the Coronary Care Unit of the Department
of Cardiology. Dental examinations were carried out during the
first 24 hours of hospitalization. Blood samples were taken at
admission (examination 1), after 10 to 12 days of hospitalization
(examination 2), 3 months after the acute coronary syndrome
(examination 3), and, in some patients, 6 months after the acute
episode (examination 4). This information was used to estimate
the mean serum levels of interleukin-1 (IL-1) and tumor necrosis
factor (TNF-?).
Results: Chronic periodontitis was found in all patients. The
patients were divided into two groups on the basis of periodontal
disease and clinical attachment loss (CAL). The study showed raised
mean values for TNF-? in examinations 2, 3, and 4 in patients
with more advanced periodontal disease. There was also an increase
in IL-1 concentration in the acute phase and in long-term observation
(examination 3) in these patients. The patients with more advanced
CAL had more pronounced periodontal disease and higher bleeding
index values. All patients were characterized by high mean values
of plaque index (46%) and bleeding index (80%).
Conclusions: The periodontal health of patients admitted to the
Coronary Care Unit due to acute coronary syndrome is unacceptable.
The mean values for CAL and probing depth, as well as extensive
bleeding on probing sites indicate the presence of active periodontal
disease, which may affect the incidence of cardiovascular disease.
Although there were no significant differences in serum TNF-?
Or IL-1 levels in acute coronary disease patients with advanced
periodontal disease compared to those with less advanced periodontal
disease, we observed that patients with acute coronary syndrome
and with more advanced periodontal disease tend to be characterized
by higher mean values of serum concentrations of IL-1 in the acute
phase of acute coronary syndrome, as well as in the long term,
and of TNF-? in the long-term observation. Patients with less
advanced periodontal disease were characterized by a faster diminution
of the inflammatory response in comparison to the groups with
more advanced periodontal disease.
[J Periodontol 2004;75:1020-1026]
