Periodontal Infections and Coronary
Heart Disease
from Archives of Internal Medicine
Axel Spahr, DDS; Elena Klein, DDS; Natalie Khuseyinova, MD;
Clemens Boeckh, PhD; Rainer Muche, PhD; Markus Kunze, MS; Dietrich
Rothenbacher, MD, MPH; Gita Pezeshki, PhD; Albrecht Hoffmeister,
MD; Wolfgang Koenig, MD
Arch Intern Med. 2006;166:554-559.
Background Chronic inflammation from any source is associated
with increased cardiovascular risk. Periodontitis is a possible
trigger of chronic inflammation. We investigated the possible
association between periodontitis and coronary heart disease
(CHD), focusing on microbiological aspects.
Methods A total of 789 subjects (263 patients with angiographically
confirmed, stable CHD and 526 population-based, age- and sex-matched
controls without a history of CHD) were included in the Coronary
Event and Periodontal Disease (CORODONT) study. Subgingival
biofilm samples were analyzed for periodontal pathogens Actinobacillus
actinomycetemcomitans, Tannerella forsythensis, Porphyromonas
gingivalis, Prevotella intermedia, and Treponema denticola
using DNA-DNA hybridization. The need for periodontal treatment
in each subject was assessed using the Community Periodontal
Index of Treatment Needs (CPITN). The main outcome measures
included total periodontal pathogen burden, number of the various
periodontal pathogens in the subgingival biofilm, and periodontal
treatment needs (according to the CPITN).
Results In multivariable analyses, we found a statistically
significant association between the periodontal pathogen burden
(log10 of the sum of all pathogens) (odds ratio [OR], 1.92;
95% confidence interval [CI], 1.34-2.74; P<.001) or the
number of A actinomycetemcomitans in periodontal pockets (log10)
(OR, 2.70; 95% CI, 1.79-4.07; P<.001) and the presence of
CHD. In addition, a statistically significant association between
an increase in mean CPITN score by 1 and the presence of CHD
(OR, 1.67; 95% CI, 1.08-2.58; P = .02) was observed.
Conclusions Our findings suggest an association between
periodontitis and presence of CHD. Periodontal pathogen burden,
and particularly infection with A actinomycetemcomitans, may
be of special importance.
Author Affiliations: Departments of Operative Dentistry and Periodontology (Drs Spahr, Klein, Boeckh, and Pezeshki), Internal Medicine II–Cardiology (Drs Khuseyinova, Hoffmeister, and Koenig and Mr Kunze), and Biometry and Medical Documentation (Dr Muche), University of Ulm Medical Center, Ulm, Germany; and Department of Epidemiology (Dr Rothenbacher), The German Center for Research on Aging, Heidelberg, Germany.
