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Interaction between periodontal disease and atherosclerotic vascular disease – Fact or fiction?

      Highlights

      • There is a consistent association between periodontal disease and 10-year risk of atherosclerotic vascular disease.
      • Atherosclerotic vascular disease and periodontal disease may influence each other via systemic effects.
      • Periodontal treatment can improve endothelial function and other risk markers of atherosclerosis.
      • Lowering LDL-cholesterol by statins prevents or reduces periodontal disease.

      Abstract

      C-reactive protein (CRP) level is associated with the 10-year risk of an atherosclerotic vascular disease (ASVD), suggesting presence of systemic inflammation probably long before ASVD is present. Where, however, does this systemic inflammation come from? One active area of research has been the study of dental infection and various forms of periodontal disease (PD), both of which are highly prevalent in populations at risk for ASVD. Recent data show that ASVD and PD interact with each other via systemic release of specific pro- and anti-inflammatory cytokines, small signal molecules and enzymes which modulate initiation and progression of the chronic inflammatory reaction involved in both diseases. In addition, periodontal pathogens were identified within atherosclerotic lesions and thrombi isolated from myocardial infarction patients. LDL cholesterol, a strong risk factor for ASVD, is also associated with PD; and statins, used to treat ASVD, are also active to prevent or reduce PD. Finally, there is growing evidence for common genetic susceptibility factors involved in both diseases. These findings support commonalities with respect to the pathogenic mechanisms involved in both inflammatory diseases. Conversely, a causative relationship cannot yet be concluded in the absence of data from large longitudinal cohort and randomized controlled intervention trials.

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