Universidad de Buenos Aires, Facultad de Odontología, Cátedra de Medicina Interna, Buenos Aires, Argentina.
Departamento de Cardiología, Hospital Español, Buenos Aires, Argentina.
Acta Odontol Latinoam. 2020 Dec 1;33(3):200-208.
Severe periodontal disease (SPD) associated with systemic peripheral inflammation, cognitive impairment (CI) and arterial stiffness (AS) has been recognized. The aim of this study was to investigate whether CI and arterial stiffness (AS) occur in cardiovascular disease (CVD) patients with SPD. A crosssectional case-control study included hospitalized patients with CVD. Demographic characteristics, CVD and atherogenic risk factors were recorded. SPD was diagnosed by clinical and radiographic dental examinations. Dental clinical attachment level (CAL) and CAL % were recorded. A Mini-Mental State Examination test (MMSE) assessed cognition, a MMSE score of < 27 was set as the cut-off point of CI; a score ≥ 27 was considered as no CI. Patients were categorized into: MMSE<27 (cases) and MMSE≥27 (controls). AS was evaluated by pulse wave velocity (PWV). Serum VCAM-1 levels were determined in a random sample. Results: This study comprised 91 patients (cases, n=26; 29.6%; controls, n=65, 71.4%); aged 73±8 vs. 73±7 years, respectively (p=0.73), of whom 53.8% and 36.9% respectively, were women; SPD was found to be a risk factor for CI; the presence of SPD increased the risk for MMSE <27 by an average 5.39 times (model 1). PWV was associated with MMSE < 27 in the three models. The risk of having MMSE < 27 increased an average of 2.404-fold for each 1-unit increase in PWV. SPD and AS had significant and independent associations on the risk for development CI. MMSE negatively correlated with CAL% (r=0.69) and PWV (r=0.70). PWV positively correlated with CAL% (r=0.67). Serum VCAM-1 levels were higher in SPD with lower MMSE scores. In conclusion, SPD increases the risk of development of cognitive decline in CVD patients. PWV was directly associated with the risk of cognitive decline. These findings denote a significant opportunity to improve periodontal health in order to avert CI in CVD patients.
严重牙周病（SPD）与全身外周炎症、认知障碍（CI）和动脉僵硬（AS）有关。本研究旨在探讨 CVD 患者中是否存在 SPD 相关的 CI 和动脉僵硬。这是一项横断面病例对照研究，纳入了住院 CVD 患者。记录了人口统计学特征、CVD 和动脉粥样硬化危险因素。通过临床和放射牙科检查诊断 SPD。记录了牙周临床附着水平（CAL）和 CAL%。采用简易精神状态检查测试（MMSE）评估认知，将 MMSE 评分<27 作为 CI 的截断点；评分≥27 被认为无 CI。将患者分为：MMSE<27（病例）和 MMSE≥27（对照）。通过脉搏波速度（PWV）评估 AS。随机样本测定血清 VCAM-1 水平。结果：本研究共纳入 91 例患者（病例 26 例，29.6%；对照 65 例，71.4%）；年龄分别为 73±8 岁和 73±7 岁（p=0.73），其中 53.8%和 36.9%分别为女性；SPD 是 CI 的危险因素；SPD 使 MMSE<27 的风险平均增加 5.39 倍（模型 1）。在三个模型中，PWV 与 MMSE<27 相关。PWV 每增加 1 个单位，发生 MMSE<27 的风险平均增加 2.404 倍。SPD 和 AS 与 CI 发生风险具有显著的独立相关性。MMSE 与 CAL%（r=0.69）和 PWV（r=0.70）呈负相关。PWV 与 CAL%（r=0.67）呈正相关。血清 VCAM-1 水平在 MMSE 评分较低的 SPD 患者中更高。结论：SPD 增加了 CVD 患者认知能力下降的风险。PWV 与认知能力下降的风险直接相关。这些发现表明，为了避免 CVD 患者发生 CI，改善牙周健康具有重要意义。
