Forsyth Institute, Cambridge, MA.
Harvard School of Dental Medicine, Boston, MA.
J Periodontol. 2021 Mar;92(3):348-358. doi: 10.1002/JPER.19-0441. Epub 2021 Feb 13.
While growing evidence suggests a link between periodontal disease (PD) and cardiovascular disease (CVD), the independence of this association and the pathway remain unclear. Herein, we tested the hypotheses that: (1) inflammation of the periodontium (PD ) predicts future CVD independently of disease risk factors shared between CVD and PD, and (2) the mechanism linking the two diseases involves heightened arterial inflammation.
F-fluorodeoxyglucose positron emission tomography/computed tomography ( F-FDG-PET/CT) imaging was performed in 304 individuals (median age 54 years; 42.4% male) largely for cancer screening; individuals without active cancer were included. PD and arterial inflammation were quantified using validated F-FDG-PET/CT methods. Additionally, we evaluated the relationship between PD and subsequent major adverse cardiovascular events (MACE) using Cox models and log-rank tests.
Thirteen individuals developed MACE during follow-up (median 4.1 years). PD associated with arterial inflammation, remaining significant after adjusting for PD and CVD risk factors (standardized β [95% CI]: 0.30 [0.20-0.40], P < 0.001). PD predicted subsequent MACE (standardized HR [95% CI]: 2.25 [1.47 to 3.44], P <0.001, remaining significant in multivariable models), while periodontal bone loss did not. Furthermore, mediation analysis suggested that arterial inflammation accounts for 80% of the relationship between PD and MACE (standardized log odds ratio [95% CI]: 0.438 [0.019-0.880], P = 0.022).
PD is independently associated with MACE via a mechanism that may involve increased arterial inflammation. These findings provide important support for an independent relationship between PD and CVD.
越来越多的证据表明牙周病（PD）与心血管疾病（CVD）之间存在关联，但这种关联的独立性及其途径仍不清楚。在此，我们检验了以下两个假设：（1）牙周炎（PD）的炎症可独立于 PD 和 CVD 之间共同的疾病风险因素预测未来 CVD 的发生；（2）连接这两种疾病的机制涉及动脉炎症的加剧。
304 名个体（中位年龄 54 岁；42.4%为男性）进行 F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（ F-FDG-PET/CT）成像，主要用于癌症筛查；包括无活动性癌症的个体。使用经过验证的 F-FDG-PET/CT 方法对 PD 和动脉炎症进行定量。此外，我们使用 Cox 模型和对数秩检验评估 PD 与随后发生的主要不良心血管事件（MACE）之间的关系。
在随访期间，有 13 名个体发生 MACE（中位随访时间 4.1 年）。PD 与动脉炎症相关，在调整 PD 和 CVD 风险因素后仍具有统计学意义（标准化β[95%CI]：0.30[0.20-0.40]， P <0.001）。PD 预测随后发生的 MACE（标准化 HR[95%CI]：2.25[1.47 至 3.44]， P <0.001，在多变量模型中仍具有统计学意义），而牙周骨丧失则没有。此外，中介分析表明，动脉炎症解释了 PD 与 MACE 之间 80%的关系（标准化对数优势比[95%CI]：0.438[0.019-0.880]， P =0.022）。
PD 通过可能涉及动脉炎症增加的机制与 MACE 独立相关。这些发现为 PD 与 CVD 之间存在独立关系提供了重要支持。
