Malthaner Scott C, Moore Scott, Mills Michael, Saad Robert, Sabatini Robert, Takacs Vincent, McMahan Alex C, Oates Thomas W
Department of Periodontics, Wilford Hall Medical Center, Lackland Air Force Base, San Antonio, TX, USA.
J Periodontol. 2002 Oct;73(10):1169-76. doi: 10.1902/jop.2002.73.10.1169.
The association between periodontal disease and coronary artery disease (CAD) has been investigated in numerous studies with inconsistent results. Resolving these differences is complicated by the use of varying definitions of CAD. The aim of this study was to investigate the association between angiographically-defined CAD and periodontal disease.
Non-smoking, non-diabetic patients, over 40 years of age, with no history of a myocardial infarction in the previous 6 months and who had undergone cardiac catheterization within the previous 12 months were enrolled in this study. Subjects were classified as having CAD (CAD+) if they had 50% stenosis in at least one major epicardial artery and classified as CAD negative (CAD-) if they had <50% stenosis in all identified arteries. Periodontal disease severity was measured through bleeding on probing, probing depth, clinical attachment level (CAL), gingival recession, number of missing teeth, and radiographic bone loss.
One hundred (53 = CAD+; 47 = CAD-) patients were examined. CAD+ patients were more likely to be male (CAD+ 83.0% male; CAD- 40.4% male; P= 0.001), and were older (CAD+ 65.3 years; CAD- 60.8 years; P= 0.0138). Although all patients reported they were currently non-smokers and had not smoked for at least 5 years, the fraction who were former smokers was greater for CAD+ patients (66% versus 24.4%; P = 0.0001) and mean pack/year history of smoking was higher for CAD+ patients (15.8 versus 4.5; P = 0.0003). Mean CAL (3.13 mm versus 2.78 mm; P 0.0227), number of sites with CAL > or = 6 mm (6.85 versus 3.32; P = 0.0242), radiographic bone loss (3.60 mm versus 3.18 mm; P = 0.0142) were greater for CAD+ patients than for CAD- patients. However, after adjustment for age and previous smoking history, factors common to both diseases, the associations of CAD and periodontal disease were reduced and were not statistically significant (odds ratio [OR]: mean CAL OR = 1.06; number of sites with CAL > or = 6 mm OR = 1.03; mean radiographic bone loss OR = 1.31; P > or = 0.2055).
After accounting for factors common to both periodontal disease and CAD, there was no significant association between periodontal disease and chronic CAD as assessed angiographically. Further investigations into the relationship between periodontal disease and CAD should clearly separate chronic CAD and acute coronary events.
众多研究对牙周病与冠状动脉疾病（CAD）之间的关联进行了调查，但结果并不一致。CAD定义的差异使得解决这些分歧变得复杂。本研究的目的是调查血管造影定义的CAD与牙周病之间的关联。
本研究纳入了年龄超过40岁、在过去6个月内无心肌梗死病史且在过去12个月内接受过心脏导管插入术的非吸烟、非糖尿病患者。如果受试者至少一条主要心外膜动脉狭窄50%，则分类为患有CAD（CAD+）；如果所有已识别动脉的狭窄程度均<50%，则分类为CAD阴性（CAD-）。通过探诊出血、探诊深度、临床附着水平（CAL）、牙龈退缩、缺失牙数量和影像学骨丢失来测量牙周病严重程度。
共检查了100名患者（53例CAD+；47例CAD-）。CAD+患者更可能为男性（CAD+组男性占83.0%；CAD-组男性占40.4%；P = 0.001），且年龄更大（CAD+组65.3岁；CAD-组60.8岁；P = 0.0138）。尽管所有患者均报告目前不吸烟且至少已戒烟5年，但CAD+患者中既往吸烟者的比例更高（66%对24.4%；P = 0.0001），CAD+患者的平均包年吸烟史更高（15.8对4.5；P = 0.0003）。CAD+患者的平均CAL（3.13 mm对2.78 mm；P = 0.0227）、CAL≥6 mm的部位数量（6.85对3.32；P = 0.0242）、影像学骨丢失（3.60 mm对3.18 mm；P = 0.0142）均高于CAD-患者。然而，在对年龄和既往吸烟史这两种疾病共有的因素进行调整后，CAD与牙周病之间的关联减弱且无统计学意义（优势比[OR]：平均CAL的OR = 1.06；CAL≥6 mm部位数量的OR = 1.03；平均影像学骨丢失的OR = 1.31；P≥0.2055）。
在考虑牙周病和CAD共有的因素后，血管造影评估的牙周病与慢性CAD之间无显著关联。对牙周病与CAD关系的进一步研究应明确区分慢性CAD和急性冠状动脉事件。
