Relationship between periodontal status and C-reactive protein and interleuckin-6 levels among atherosclerotic patients in Bandar Abbas, Iran in 2014
Keywords:
periodontal diseases, atherosclerosis, probe depth (PD), clinical attachment loss (CAL)Abstract
Background: Recent studies have reported an association between periodontitis and cardiovascular diseases. Atherosclerosis is also a risk factor for cardiovascular diseases. IL-6 and CRP are important inflammatory markers that are important because they have been shown to be higher when a patient has periodontitis, and they are related to atherosclerosis. The aim of this study was to assess the relationship between periodontitis and CRP and IL-6 in atherosclerotic patients.
Methods: The study population in this case control study was atherosclerotic patients in Bandar Abbas, Iran in 2014. The participants included 30 individuals with periodontal diseases and 30 individuals without periodontal diseases, and they were allocated into two groups according to probe depth (PD) and clinical attachment loss (CAL). Inflammatory markers, including CRP and IL-6 were measured in the two groups. The data were analyzed using IBM SPSS 21 statistical software. Descriptive statistics, chi-squared, independent samples t-test, and Mann-Whitney tests were used to analyze the data.
Results: Individuals with abnormal CRP had significantly higher PD and CAL than individuals with normal CRP (P<0.001). Although PD was not significantly different in individuals with normal and abnormal IL-6 (P=0.124), CAL was significantly higher in individuals with abnormal IL-6 than in the other individuals (P=0.005).
Conclusion: The results of this study showed that CRP and IL-6 are associated with periodontal diseases in atherosclerotic patients. Treatment of periodontal diseases is recommended in atherosclerotic patients.
References
Peter B. Lockhart, Ann F. Bolger, Panos N. Papapanou, Olusegun Osinbowale, Maurizio Trevisan, Matthew E.
Levison et al. Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an
Independent Association?: A Scientific Statement From the American Heart Association. 2012;125:2520-2544;
originally published online April 18, 2012. doi:10.1161/CIR.0b013e31825719f3. PMID: 22514251.url:
http://dx.doi.org/10.1161/CIR.0b013e31825719f3
Paul M Ridker, Eleanor Danielson, Francisco A.H. Fonseca,Jacques Genest, Antonio M. Gotto, Jr., John J.P. et
al. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. N Engl J
Med 2008; 359:2195-2207. November 20, 2008.DOI: 10.1056/NEJMoa0807646. PMID: 18997196.url:
http://dx.doi.org/10.1056/NEJMoa0807646
Malthaner SC1, Moore S, Mills M, Saad R, Sabatini R, Takacs V, et al. Investigation of the association between
angiographically defined coronary artery disease and periodontal disease. J Periodontol. 2002 Oct;73(10):1169- 76. http://dx.doi.org/10.1902/jop.2002.73.10.1169. PMid:12416775
Craig RG, Spittle MA, Levin NW. Importance of periodontal disease in the kidney patient. Blood Purif.
;20(1):113-9. http://dx.doi.org/10.1159/000046994. PMid:11803168
Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995 Aug 1;92(3):657-71.
http://dx.doi.org/10.1161/01.CIR.92.3.657. PMid:7634481
Tonetti MS. Periodontitis and risk for atherosclerosis: an update on intervention trials. J Clin Periodontol. J Clin
Periodontol. 2009 Jul;36 Suppl 10:15-9.url: http://dx.doi.org/10.1111/j.1600-051X.2009.01417.x.
PMid:19432627
Kaptoge S, Di Angelantonio E, Lowe G, Pepys MB, Thompson SG, Collins R, Danesh J.et al. C-reactive
protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta- analysis. Lancet. 2010 Jan 9;375(9709):132-40. doi: 10.1016/S0140-6736(09)61717-7. Epub 2009 Dec 22.
PMID: 20031199.url: http://dx.doi.org/10.1016/S0140-6736(09)61717-7
Ridker PM, Danielson E, Fonseca FA, Genest J, Gotto AM Jr, Kastelein JJ.et al. Rosuvastatin to prevent
vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008 Nov 20;359(21):2195- 207. doi: 10.1056/NEJMoa0807646. Epub 2008 Nov 9. PMID: 18997196 .url:
http://dx.doi.org/10.1056/NEJMoa080764
Mohammad Madjid, MSc, Muzammil Ali, and James T. Willerson, Lipoprotein-Associated Phospholipase A2
as a Novel Risk Marker for Cardiovascular Disease. Tex Heart Inst J. 2010; 37(1): 25–39. PMCID:
PMC2829807
Söder PO, Meurman JH, Jogestrand T, Nowak J, Söder B. Matrix metalloproteinase-9 and tissue inhibitor of
matrix metalloproteinase-1 in blood as markers for early atherosclerosis in subjects with chronic periodontitis. J
Periodontal Res. 2009 Aug;44(4):452-8. doi: 10.1111/j.1600-0765.2008.01145.x. Epub 2008 Oct 22.
url:http://dx.doi.org/10.1111/j.1600-0765.2008.01145.x
Heslop CL, Frohlich JJ, Hill JS. Myeloperoxidase and C-reactive protein have combined utility for long-term
prediction of cardiovascular mortality after coronary angiography. J Am Coll Cardiol. 2010 Mar
;55(11):1102-9. doi: 10.1016/j.jacc.2009.11.050. url : http://dx.doi.org/10.1016/j.jacc.2009.11.050 . PMID:
Green D, Foiles N, Chan C, Schreiner PJ, Liu K. Elevated fibrinogen levels and subsequent subclinical
atherosclerosis: the CARDIA Study. Atherosclerosis. 2009 Feb;202(2):623-31. doi:
1016/j.atherosclerosis.2008.05.039. Epub 2008 Jul 3. PMID: 18602107.
url:http://dx.doi.org/10.1016/j.atherosclerosis.2008.05.039
Danesh J, Lewington S, Thompson SG, Lowe GD, Collins R, Kostis JB,et al. Plasma fibrinogen level and the
risk of major cardiovascular diseases and nonvascular mortality: an individual participant meta-analysis. JAMA.
Oct 12;294(14):1799-809.PMid:16219884
Loos BG, Craandijk J, Hoek FJ, Wertheim-van Dillen PM, van der Velden U. Elevation of systemic markers
related to cardiovascular diseases in the peripheral blood of periodontitis patients. J Periodontol. 2000
Oct;71(10):1528-34. url: http://dx.doi.org/10.1902/jop.2000.71.10 .1528.PMid:11063384
Noack B1, Genco RJ, Trevisan M, Grossi S, Zambon JJ, De Nardin E. Periodontal infections contribute to
elevated systemic C-reactive protein level. J Periodontol. 2001 Sep;72(9):1221-7.url:
http://dx.doi.org/10.1902/jop.2000.72.9.1221 . PMid:11577954
Ebersole JL, Cappelli D, Mathys EC, Steffen MJ, Singer RE, Montgomery M, Periodontitis in humans and non- human primates: oral-systemic linkage inducing acute phase proteins. Ann Periodontol. 2002 Dec;7(1):102-11.
url: http://dx.doi.org/10.1902/annals.2002.7.1.102 . PMid:16013223
Loos BG. Systemic markers of inflammation in periodontitis. J Periodontol. 2005 Nov;76(11 Suppl):2106- 15.url: http://dx.doi.org/10.1902/jop.2005.76.11-S.2106 . PMid:16277583
Maekawa T, Tabeta K, Kajita-Okui K, Nakajima T, Yamazaki K. Increased expression of C-reactive protein
gene in inflamed gingival tissues could be derived from endothelial cells stimulated with interleukin-6. Arch
Oral Biol. 2011 Nov;56(11):1312-8. doi: 10.1016/j.archoralbio.2011.04.010. Epub 2011 May 8.url:
http://dx.doi.org/10.1016/j.archoralbio.2011.04.010 . PMID: 21550586
Lu Q, Jin L. Human gingiva is another site of C-reactive protein formation. J Clin Periodontol. 2010
Sep;37(9):789-96. doi: 10.1111/j.1600-051X.2010.01600.x. Epub 2010 Jul 21.url:
http://dx.doi.org/10.1111/j.1600-051X.2010.01600.x . PMID: 20666874
Hujoel PP, White BA, García RI, Listgarten MA. The dentogingival epithelial surface area revisited. J
Periodontal Res. 2001 Feb;36(1):48-55.url: http://dx.doi.org/10.1034/j.1600-0765.2001.00011.x .
PMid:11246704
Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK, et al. Poor oral
hygiene as a risk factor for infective endocarditis-related bacteremia. J Am Dent Assoc. 2009
Oct;140(10):1238-44. url: http://dx.doi.org/10.14219/jada.archive.2009.0046 . PMid:19797553
PMCid:PMC2770162
Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK. Bacteremia associated with
toothbrushing and dental extraction. Circulation. 2008 Jun 17;117(24):3118-25. doi:
1161/CIRCULATIONAHA.107.758524. Epub 2008 Jun 9.url:
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.758524 . PMID: 18541739 PMCID: PMC2746717
Bahrani-Mougeot FK, Paster BJ, Coleman S, Ashar J, Barbuto S, Lockhart PB. Diverse and novel oral bacterial
species in blood following dental procedures. J Clin Microbiol. 2008 Jun;46(6):2129-32. doi:
1128/JCM.02004-07. Epub 2008 Apr 23.url: http://dx.doi.org/10.1128/JCM.02004-07 . PMID: 18434561 .
PMCID: PMC2446827
R Bayliss, C Clarke, C M Oakley, W Somerville, A G Whitfield, and S E Young. The microbiology and
pathogenesis of infective endocarditis. Br Heart J. Dec 1983; 50(6): 513–519.url:
http://dx.doi.org/10.1136/hrt.50.6.513 . PMid:6651993 PMCid:PMC481452
van der Meer JT, Thompson J, Valkenburg HA, Michel MF. Epidemiology of bacterial endocarditis in The
Netherlands. . Patient characteristics. Arch Intern Med. 1992 Sep;152(9):1863-8. url:
http://dx.doi.org/10.1001/archinte.1992.00400210087014 . PMid:1520052
Strom BL, Abrutyn E, Berlin JA, Kinman JL, Feldman RS, Stolley PD, Levison ME. Dental and cardiac risk
factors for infective endocarditis. A population-based, case-control study. Ann Intern Med. 1998 Nov
;129(10):761-9.url: http://dx.doi.org/10.7326/0003-4819-129-10-199811150-00002 . PMid:9841581
Dorn BR, Dunn WA Jr, Progulske-Fox A. Invasion of human coronary artery cells by periodontal pathogens.
Infect Immun. 1999 Nov;67(11):5792-8. PMid:10531230 PMCid:PMC96956
Deng H, Wu YF, Ding Y, Miao D, Gao L, Guo SJ. et al.Invasion of four common periodontal pathogens into
vascular endothelial cells in vitro. Zhonghua Kou Qiang Yi Xue Za Zhi. 2010 Apr;45(4):203-6. PMid:20654193
Roth GA, Moser B, Huang SJ, Brandt JS, Huang Y, Papapanou PN. Infection with a periodontal pathogen
induces procoagulant effects in human aortic endothelial cells. J Thromb Haemost. 2006 Oct;4(10):2256-61.url:
http://dx.doi.org/10.1111/j.1538-7836.2006.02128.x . PMid:16856978
Fiehn NE, Larsen T, Christiansen N, Holmstrup P, Schroeder TV. Identification of periodontal pathogens in
atherosclerotic vessels. J Periodontol. 2005 May;76(5):731-6.url: http://dx.doi.org/10.1902/jop.2005.76.5.731 .
PMid:15898933
Newman, M.G., Takei, H.H., Klokkevold, P.N. & Carranza, N.T. Carranza’s Clinical Periodontology (11th ed.).
St-Louis, Missouri: Saunders Elsevier. 2012: 80-88.
Antonopoulos AS, Margaritis M, Lee R, Channon K, Antoniades C. Statins as anti-inflammatory agents in
atherogenesis: molecular mechanisms and lessons from the recent clinical trials. Curr Pharm Des.
;18(11):1519-30.url: http://dx.doi.org/10.2174/138161212799504803 . PMCid:PMC3394171. PMID:
Nakajima T, Honda T, Domon H, Okui T, Kajita K, Ito H, Takahashi N, et al. Periodontitis-associated upregulation of systemic inflammatory mediator level may increase the risk of coronary heart disease. J
Periodontal Res. 2010 Feb;45(1):116-22. doi: 10.1111/j.1600-0765.2009.01209.x. Epub 2009 Jul 8. url:
http://dx.doi.org/10.1111/j.1600-0765.2009.01209.x . PMID: 19602107
Buhlin K, Hultin M, Norderyd O, Persson L, Pockley AG, Pussinen PJ, et al. Periodontal treatment influences
risk markers for atherosclerosis in patients with severe periodontitis. Atherosclerosis. 2009 Oct;206(2):518-22.
doi: 10.1016/j.atherosclerosis.2009.03.035. Epub 2009 Apr 5. url:
http://dx.doi.org/10.1016/j.atherosclerosis.2009.03.035 . PMID: 19411077
Noack B, Genco RJ, Trevisan M, Grossi S, Zambon JJ, De Nardin E. Periodontal infections contribute to
elevated systemic C-reactive protein level. J Periodontol. 2001 Sep;72(9):1221-7.url:
http://dx.doi.org/10.1902/jop.2000.72.9.1221 . PMid:11577954
Buhlin K, Gustafsson A, Pockley AG, Frostegård J, Klinge B. Risk factors for cardiovascular disease in patients
with periodontitis. Eur Heart J. 2003 Dec;24(23):2099-107.url: http://dx.doi.org/10.1016/j.ehj.2003.09.016 .
PMid:14643270
Elkaïm R, Dahan M, Kocgozlu L, Werner S, Kanter D, Kretz JG, et al. Prevalence of periodontal pathogens in
subgingival lesions, atherosclerotic plaques and healthy blood vessels: a preliminary study. J Periodontal Res.
Apr;43(2):224-31. url: http://dx.doi.org/10.1111/j.1600-0765.2007.01018.x . PMid:18326058
Published
Issue
Section
License
Copyright (c) 2020 KNOWLEDGE KINGDOM PUBLISHING
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
