Preventive cardiology
Usefulness of Self-Reported Periodontal Disease to Identify Individuals With Elevated Inflammatory Markers at Risk of Cardiovascular Disease

https://doi.org/10.1016/j.amjcard.2008.07.047Get rights and content

Periodontal disease has been associated with cardiovascular disease (CVD), and inflammation may represent a common pathophysiology. Oral health screening in the context of CVD risk assessment represents a potential opportunity to identify individuals at risk for CVD. The purposes of this study were to determine if self-reported oral health status is independently associated with inflammatory markers and if oral health assessment as part of CVD risk screening can identify at-risk individuals without traditional CVD risk factors. A baseline analysis was conducted among participants in the National Heart, Lung, and Blood Institute's Family Intervention Trial for Heart Health (FIT Heart; n = 421, mean age 48 ± 13.5 years, 36% nonwhite) without CVD or diabetes who underwent standardized assessment of oral health, lifestyle, CVD risk factors, and the inflammatory markers high-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2. Statistical associations between oral health, risk factors, and inflammatory markers were assessed, and logistic regression was used to adjust for effects of lifestyle and potential confounders. Periodontal disease was independently associated with being in the top quartile of lipoprotein-associated phospholipase A2 compared with the lower 3 quartiles (odds ratio 1.9, 95% confidence interval 1.1 to 3.2) after adjustment for lifestyle and risk factors. Histories of periodontal disease were reported by 24% of nonoverweight, nonhypertensive, nonhypercholesterolemic participants, and of these participants, 37% had elevated high-sensitivity C-reactive protein (≥3 mg/L) or lipoprotein-associated phospholipase A2 (≥215 ng/ml) levels. In conclusion, self-reported periodontal disease is independently associated with inflammation and common in individuals without traditional CVD risk factors.

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Methods

This was a cross-sectional baseline substudy of consecutively enrolled participants in the National Heart, Lung, and Blood Institute's Family Intervention Trial for Heart Health (FIT Heart; n = 421, mean age 48 ± 13.5 years, 36% racial or ethnic minorities), designed to test the effectiveness of a screening and educational intervention for family members of patients hospitalized with CVD. Participants were eligible if they were family members or cohabitants of patients hospitalized with CVD,

Results

The baseline characteristics of 421 consecutively enrolled participants in the FIT Heart study in this analysis are listed in Table 1. The mean age was 48 ± 13.5 years. The median hsCRP level was 1.05 mg/L (hsCRP ≥10.0 mg/L excluded [n = 1]). The median Lp-PLA2 level among all participants was 189.3 ng/ml, with 25% of participants having Lp-PLA2 levels ≥215 ng/ml. Age and hsCRP were not correlated (r = −0.01, p = 0.85); nor were age and Lp-PLA2 (r = 0.05, p = 0.28) or Lp-PLA2 and hsCRP (r =

Discussion

In a diverse population of individuals eligible for the primary prevention of CVD, a history of periodontal disease was associated with significantly higher levels of Lp-PLA2 compared with those without periodontal disease. When adjusted for potential confounders and lifestyle factors, this association remained statistically significant. To our knowledge, this is the first report of an association between oral health and Lp-PLA2. These data support a possible independent association between

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  • Cited by (0)

    This study was funded by a Research Project Award to Dr. Mosca (R01 HL 075101-01A1) from the National Institutes of Health, Bethesda, Maryland, and supported in part by the Clinical and Translational Science Award Center at Columbia University Medical Center, New York, New York, and a Research Career Award to Dr. Mosca (K24 HL076346-01A1) from the National Institutes of Health.

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