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Gum Health Helps Prevent Heart Disease

Gum Health Helps Prevent Heart Disease
Tue, 11/05/13 – 09:09

A new study has found that improved gum health significantly parallels slow progression of atherosclerosis, a major risk factor for heart disease, stroke, and death.

According to lead study author Moïse Desvarieux, MD, PhD, Principal Investigator of the National Institutes of Health (NIH)–funded Oral Infections and Vascular Disease Epidemiology Study (INVEST) cohort, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, this study is significant in that “it provides a potential mechanism for the purported relationship between periodontal status and cardiovascular disease and importantly provides a timeline, with the results having been observed over a median time of 3 years.”

In addition, “because the results were observed in a population setting, they certainly support the importance of primary prevention as a potential preventive measure, even for periodontal status that are not yet ‘diseased.’”

He added that their results also provide a target for future clinical trials. Researchers followed 420 individuals from INVEST for their analysis. Participants were examined for periodontal infection over a median follow-up period of 3 years. Overall, 5008 subgingival samples (an average of 7 samples per patient) were collected beneath the gum and analyzed for 11 periodontal bacterial species linked to periodontal disease and seven control bacteria.

The authors also took samples of fluid from around the gums to assess for levels of interleukin-1β, which is a marker of inflammation. High-resolution ultrasound was used to measure intima‐medial thickness (IMT) in both carotid arteries.

Desvarieux and colleagues found that improvement in both clinical and microbial periodontal status correlates with a decreased rate of carotid artery IMT progression. Results were adjusted for the following potential confounders: age, sex, race/ethnicity, diabetes, smoking status, education, body mass index, systolic blood pressure, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol.

“These are the first results to show that improvement in periodontal status—both clinical improvement and improvement in the microbacterial profile in the mouth—is associated with slower progression in carotid atherosclerosis in a population where patients have been followed for years,” said Desvarieux.

In addition, “This improvement is related only to the presence of specific bacteria thought to be linked to periodontal disease, and not to the set of other bacteria that are also in the mouth and that we used as controls.”

He explained that this is important “because otherwise, we could have thought that people with higher levels of any bacteria simply take less care of themselves and have overall less healthy lifestyle. This is not the case, since the relationship only holds for the specific bacteria linked to periodontal status.” Previous studies have linked an increase in carotid IMT of 0.033 mm per year to a 2.3-fold increased risk of heart attack and stroke.

Desvarieux and colleagues found a 0.1 mm difference in IMT change over 3 years of follow-up among those whose periodontal health worsened compared with the patients whose periodontal health improved.

“We were surprised by the magnitude of the difference in IMT progression that we saw, while measuring carotid atherosclerosis,” he said. “The magnitude of difference in IMT thickness we report is equivalent to about a 2.3-fold increase in coronary events, based on previous studies by other investigators.”

Some potential limitations of the study are that “we still need longer follow-up to address the issue of lag time between periodontal status and subclinical vascular disease and we do not yet have the relationship with clinical events (myocardioal infarction and strokes),” said Desvarieux.

In terms of their future research, Desvarieux noted that their next steps are twofold: to continue to follow these patients to quantify the relationship on longer follow-up and the translation to clinical events, and “to potentially intervene on a subset of the population to see if modification of the periodontal status and of the gum microbial profile can modify the curve of atherosclerosis progression,” he said. This study is available in the Journal of the American Heart Association.

This study is available in the Journal of the American Heart Association. Funding was provided by the NIH, National Institute for Dental and Craniofacial Research, the National Institute of Neurological Disorders and Stroke, and the Institut National de la Santé et de la Recherche Medicale (INSERM), among others.

-Meredith Edwards White

Reference

Desvarieux M, Demmer RT, Jacobs DR, Papapanou PN, Sacco RL, Rundek T. Changes in clinical and microbiological periodontal profiles relate to progression of carotid intima-media thickness: the oral infections and vascular disease epidemiology study. J Am Heart Assoc. 2013 Oct 28;2(6):e000254. doi: 10.1161/JAHA.113.000254.