Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Merck Sharp & Dohme Corp., Whitehouse Station, New Jersey.
J Am Coll Cardiol. 2013 Dec 24;62(25):2382-2391. doi: 10.1016/j.jacc.2013.08.1627. Epub 2013 Sep 24.
The purpose of this study was to test whether high-dose statin treatment would result in a reduction in periodontal inflammation as assessed by (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET)/computed tomography (CT).
Periodontal disease (PD) is an independent risk factor for atherosclerosis.
Eighty-three adults with risk factors or with established atherosclerosis and who were not taking high-dose statins were randomized to atorvastatin 80 mg vs. 10 mg in a multicenter, double-blind trial to evaluate the impact of atorvastatin on arterial inflammation. Subjects were evaluated using FDG-PET/CT at baseline and at 4 and 12 weeks. Arterial and periodontal tracer activity was assessed while blinded to treatment allocation, clinical characteristics, and temporal sequence. Periodontal bone loss (an index of PD severity) was evaluated using contrast-enhanced CT images while blinded to clinical and imaging data.
Seventy-one subjects completed the study, and 59 provided periodontal images for analysis. At baseline, areas of severe PD had higher target-to-background ratio (TBR) compared with areas without severe PD (mean TBR: 3.83 [95% confidence interval (CI): 3.36 to 4.30] vs. 3.18 [95% CI: 2.91 to 3.44], p = 0.004). After 12 weeks, there was a significant reduction in periodontal inflammation in patients randomized to atorvastatin 80 mg vs. 10 mg (ΔTBR 80 mg vs. 10 mg group: mean -0.43 [95% CI: -0.83 to -0.02], p = 0.04). Between-group differences were greater in patients with higher periodontal inflammation at baseline (mean -0.74 [95% CI: -1.29 to -0.19], p = 0.01) and in patients with severe bone loss at baseline (-0.61 [95% CI: -1.16 to -0.054], p = 0.03). Furthermore, the changes in periodontal inflammation correlated with changes in carotid inflammation (R = 0.61, p < 0.001).
High-dose atorvastatin reduces periodontal inflammation, suggesting a newly recognized effect of statins. Given the concomitant changes observed in periodontal and arterial inflammation, these data raise the possibility that a portion of that beneficial impact of statins on atherosclerosis relate to reductions in extra-arterial inflammation, for example, periodontitis. (Evaluate the Utility of 18FDG-PET as a Tool to Quantify Atherosclerotic Plaque; NCT00703261).
本研究旨在通过（18）F-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）/计算机断层扫描（CT）评估高剂量他汀类药物治疗是否会减少牙周炎炎症。
牙周病（PD）是动脉粥样硬化的独立危险因素。
83 名患有危险因素或已确诊动脉粥样硬化且未服用高剂量他汀类药物的成年人在多中心、双盲试验中随机接受阿托伐他汀 80mg 与 10mg，以评估阿托伐他汀对动脉炎症的影响。受试者在基线和 4 周及 12 周时使用 FDG-PET/CT 进行评估。在不知道治疗分配、临床特征和时间顺序的情况下，评估动脉和牙周示踪剂活性。在不知道临床和成像数据的情况下，使用对比增强 CT 图像评估牙周骨丢失（PD 严重程度的指标）。
71 名受试者完成了研究，其中 59 名提供了牙周图像进行分析。基线时，严重 PD 区域的靶标与背景比（TBR）高于无严重 PD 区域（平均 TBR：3.83[95%置信区间（CI）：3.36-4.30]与 3.18[95%CI：2.91-3.44]，p=0.004）。12 周后，阿托伐他汀 80mg 组与 10mg 组的牙周炎炎症明显减轻（80mg 组 TBR 变化：平均-0.43[95%CI：-0.83 至-0.02]，p=0.04）。基线时牙周炎炎症较高的患者（平均-0.74[95%CI：-1.29 至-0.19]，p=0.01）和基线时严重骨丢失的患者（-0.61[95%CI：-1.16 至-0.054]，p=0.03）之间的组间差异更大。此外，牙周炎炎症的变化与颈动脉炎症的变化相关（R=0.61，p<0.001）。
高剂量阿托伐他汀可降低牙周炎炎症，表明他汀类药物具有新的作用。鉴于牙周炎和动脉粥样硬化炎症的同时变化，这些数据提示他汀类药物对动脉粥样硬化的部分有益影响可能与动脉外炎症的减少有关，例如牙周炎。（评估 18FDG-PET 作为量化动脉粥样硬化斑块的工具的效用；NCT00703261）。
