Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden.
Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center (UCR), Uppsala University, Uppsala, Sweden.
Int J Cardiol. 2017 Oct 15;245:271-276. doi: 10.1016/j.ijcard.2017.07.036. Epub 2017 Jul 17.
Underlying mechanisms behind the hypothesized relationship between periodontal disease (PD) and coronary heart disease (CHD) have been insufficiently explored. We evaluated associations between self-reported tooth loss- a marker of PD- and prognostic biomarkers in 15,456 (97%) patients with stable CHD in the global STABILITY trial.
Baseline blood samples were obtained and patients reported their number of teeth according to the following tooth loss levels: "26-32 (All)" [lowest level], "20-25", "15-19", "1-14", and "No Teeth" [highest level]. Linear and Cox regression models assessed associations between tooth loss levels and biomarker levels, and the relationship between tooth loss levels and outcomes, respectively. After multivariable adjustment, the relative biomarker increase between the highest and the lowest tooth loss level was: high-sensitivity C-reactive protein 1.21 (95% confidence interval, 1.14-1.29), interleukin 6 1.14 (1.10-1.18), lipoprotein-associated phospholipase A activity 1.05 (1.03-1.06), growth differentiation factor 15 1.11 (1.08-1.14), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) 1.18 (1.11-1.25). No association was detected for high-sensitivity troponin T 1.02 (0.98-1.05). Some attenuation of the relationship between tooth loss and outcomes resulted from the addition of biomarkers to the multivariable analysis, of which NT-proBNP had the biggest impact.
A graded and independent association between tooth loss and several prognostic biomarkers was observed, suggesting that tooth loss and its underlying mechanisms may be involved in multiple pathophysiological pathways also implicated in the development and prognosis of CHD. The association between tooth loss and cardiovascular death and stroke persisted despite comprehensive adjustment including prognostic biomarkers.
www.clinicaltrials.gov; NCT00799903.
牙周病（PD）与冠心病（CHD）之间假定关系的潜在机制尚未得到充分探讨。我们在全球 STABILITY 试验中评估了 15456 例稳定型 CHD 患者（97%）的自我报告牙齿缺失（PD 标志物）与预后生物标志物之间的相关性。
在基线时采集血液样本，患者根据以下牙齿缺失水平报告其牙齿数量：“26-32（所有）”[最低水平]、“20-25”、“15-19”、“1-14”和“无牙”[最高水平]。线性和 Cox 回归模型分别评估了牙齿缺失水平与生物标志物水平之间的相关性以及牙齿缺失水平与结局之间的关系。在多变量调整后，最高和最低牙齿缺失水平之间的相对生物标志物增加分别为：高敏 C 反应蛋白 1.21（95%置信区间，1.14-1.29）、白细胞介素 6 1.14（1.10-1.18）、脂蛋白相关磷脂酶 A 活性 1.05（1.03-1.06）、生长分化因子 15 1.11（1.08-1.14）和 N 端脑利钠肽前体（NT-proBNP）1.18（1.11-1.25）。高敏肌钙蛋白 T 为 1.02（0.98-1.05），与牙齿缺失无相关性。在多变量分析中加入生物标志物后，牙齿缺失与结局之间的关系有所减弱，其中 NT-proBNP 的影响最大。
牙齿缺失与几种预后生物标志物之间存在分级和独立的相关性，表明牙齿缺失及其潜在机制可能涉及到多个病理生理途径，这些途径也与 CHD 的发生和预后有关。尽管包括预后生物标志物在内的综合调整后，牙齿缺失与心血管死亡和卒中之间的关联仍然存在。
