Inflammation, periodontitis, and coronary heart disease
Authors: Joseph Katz, Heft Marc, Stephen Porter, Jim Ruskin
Journal: The Lancet (2001)

Marilynn Larkin refers, in her July 28 news item,1Larkin M Link between gum disease and heart disease disputed.Lancet. 2001; 358: 303Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar to the possible link between gum disease and heart disease. There is an increasing volume of evidence on the role of inflammation in the pathogenesis of coronary heart disease.2Ross R Atherosclerosis-an inflammatory disease.N Engl J Med. 1999; 340: 115-126Crossref PubMed Scopus (19823) Google Scholar An association between changes in blood lipids and infection was shown in patients with chronic chlamydia, pneumonia, and cytome-galovirus infections. Workers in those studies and others linked the release of active cytokines from activated immune cells resulting in endothelial-cell injury and initiation or exacerbation of arterial-wall inflammatory processes. Periodontal disease as a possible source for these inflammatory processes has been implicated in several reports. Higher rates of poor hygiene and periodontal disease were noted in several studies of patients with coronary atherosclerotic disease.3DeStefano F Anda RF Kahn HS et al.Dental disease and risk of coronary heart disease and mortality.BMJ. 1993; 306: 688-691Crossref PubMed Scopus (845) Google Scholar In one cross sectional study of 10 562 military staff, we showed that periodontal disease was positively associated with higher total cholesterol and LDL cholesterol blood concentrations. This association held after adjustment for body-mass index, blood pressure, diet, and physical exercise. We have also shown a strong association between coronary heart disease and severe periodontal status.4Katz J Chausho G Sharabi Y On the association between hypercholesterolemia, cardiovascular disease and severe periodontal disease.J Clin Periodontol. 2001; 28: 865-868Crossref PubMed Scopus (117) Google Scholar Furthermore, dental health is a risk factor for cerebrovascular accident and death due to cardiovascular disease.5Wu T Trevisan M Genco RJ et al.Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination and its follow-up study.Arch Intern Med. 2000; 18: 2749-2755Crossref Scopus (388) Google Scholar Periodontal disease is a common chronic inflammatory process characterised by bacterial challenge and release of cytokines such as tumour necrosis factor a and interleukins 1 and 6, which play a part in development and progression of atherosclerotic disease. Workers have also shown that periodontitis elicits a mild acute-phase response and increase in C-reactive protein. Thus, periodontal disease might provide a new link between this marker of systemic inflammation and cardiovascular risk. The strength of association between these phenomena has been challenged, but the results of many controlled studies show otherwise. As long as this issue is in dispute, we believe that the medical profession should at least inform patients susceptible to coronary heart disease of this possible correlation, and make a step towards improved oral health. There is no aggressiveness in maintaining oral hygiene and certainly it does not involve antibiotics, surgery, and other risks. Treatment of patients with carotid stenosisAuthors' reply Full-Text PDF