Peridontal Characteristics of the Study Population (n=789)

1
Peridontal Characteristics of the Study
Population (n789)
Periodontal Infections and Coronary Heart
Disease Role of Periodontal Bacteria and
Importance of Total Pathogen Burden. The
COROnary Event and PerioDONTal Disease (CORODONT)
Study
Axel Spahr1, Natalie Khuseyinova2, Elena Klein1,
Clemens Boeckh1, Rainer Muche3, Dietrich
Rothenbacher4, Albrecht Hoffmeister2, Wolfgang
Koenig2 1Department of Operative Dentistry and
Periodontology and 2Department of Internal
Medicine II- Cardiology, University of Ulm
Medical Center 3Department of Biometry and
Medical Documentation at the University of Ulm,
Ulm, Germany 4Department of Epidemiology, German
Centre for Research on Ageing at the University
of Heidelberg, Heidelberg, Germany
Introduction Chronic inflammation from any
source is associated with increased
cardiovascular risk. Periodontitis is discussed
as a possible trigger of chronic inflammation.
The aim of the present study was to investigate
the possible association between periodontal
disease and coronary heart disease (CHD) focusing
on microbiological aspects.
Results
Association Between Periodontal Pathogens and CHD
by Conditional Logistic Regression Analysis
Characteristics of the Study Population (n789)
Variable Cases Controls Unadjusted Unadjusted Adjusted Adjusted
Median Median OR (95 CI) P-Value OR (95 CI) P-Value
Total periodontal pathogen burden 79x103 38x103 1.22 (1.06-1.41) 0.006 1.92 (1.34-2.74) 0.0004
A.Actinomycetemcomitans 30x103 8x103 1.66 (1.42-1.95) lt0.0001 2.70 (1.79-4.07) lt0.0001
P.gingivalis 5x103 8x103 0.89 (0.75-1.05) 0.16 1.36 (0.94-1.95) 0.10
T.forsythensis 1x103 5x103 0.66 (0.54-0.81) lt0.0001 0.95 (0.65-1.39) 0.79
P.intermedia 10x103 10x103 0.99 (0.84-1.16) 0.86 1.43 (1.00-2.03) 0.049
T.denticola 1x103 5x103 0.66 (0.55-0.81) lt0.0001 0.94 (0.66-1.34) 0.74

• Material and Methods
• 263 Patients with clinically stable CAD aged
  43-73 years and 526 popu-lation-based, age and
  gender matched controls without history of CHD
  were recruited
• Participation rate was 71 in eligible patients
  and 67 in eligible control subjects
• Subgingival biofilm samples were analyzed for the
  main periodontal pathogens, such as
  Actinobacillus actinomycetemcomitans (A.
  actino-mycetemcomitans), Tannerella forsythensis
  (T.forsythensis), Porphyro-monas gingivalis (P.
  gingivalis), Prevotella intermedia (P.
  intermedia) and Treponema denticola (T.
  denticola), using DNA-DNA hybridisation
• The need for periodontal treatment in each
  subject was assessed using the community
  periodontal index of treatment needs (CPITN)
• Measurements of the CPITN were performed at 6
  sites of each tooth. The oral cavity of each
  patient was divided into sextants for each
  sextant the highest index found was recorded
  according to the following score 0 periodontal
  health, 1 gingival bleeding, 2 calculus
  and/or overhanging restorations, 3 pocket depth
  4-5 mm, 4 pocket depth ? 6 mm. Finally, the
  periodontal disease status of each subject was
  reported as the mean index score of all sextants.
  Additionally, the deepest pocket depth (ST-Max)
  as well as the number of missing teeth, and the
  number of toothless sextants were recorded in all
  subjects
• For all potential periodontal and microbiological
  risk factors, crude and adjusted odds ratios (OR)
  together with their 95 confidence intervals (CI)
  and the respective p-value were calculated by
  means of conditional logistic regression

for an increase in periodontal pathogens of
log (10) logamount of pathogens
logarithmically transformed to the basis of 10
adjusted for age, sex, body mass index, smoking,
alcohol consumption, diabetes, hypertension,
hyperlipoproteinemia,
school education, physical activity, and statin
intake
Variable OR (95 CI) P-Value
Total periodontal pathogen burden (log) 1.83 (1.23 2.71) 0.003
CPITN-Mean 1.15 (0.70 1.89) 0.58
A.actinomycetemcomitans (log) 2.68 (1.74 4.14) lt0.0001
CPITN-Mean 1.02 (0.62 1.70) 0.93
P.intermedia (log) 1.25 (0.85 1.84) 0.26
CPITN-Mean 1.48 (0.92 2.39) 0.10
Variable Cases (n263) Controls (n526)
CPITN
Median (IQR) 2.8 (2.3 3.3) 2.8 (2.2 3.3)
Mean (SD) 2.8 (0.8) 2.7 (0.9)
ST-max (mm)
Median (IQR) 6.0 (5.0 8.0) 6.0(5.0 8.0)
Mean (SD) 6.4 (2.4) 6.3 (2.2)
Complete tooth loss () 8 2
Partial tooth loss () 27 19
Mean number of toothless sextants (SD) 1.3 (2.0) 0.6 (1.5)
for an increase in mean CPITN of 1 unit and an
increase in periodontal pathogens of log
(10) pathogen numbers were logarithmically
transformed to the basis of 10 adjusted for
age, gender, BMI, smoking, alcohol consumption,
diabetes, hypertension, hyperlipoproteinemia,
school education, physical activity, and statin
intake
16S rDNA/rRNA Directed Probes
Association Between CPITN or ST-Max and CHD
Variable OR 95 CI P-Value
CPITN crude 1.23 1.02-1.49 0.03
CPITN adjusted 1.67 1.08-2.58 0.02
ST-max crude 1.03 0.96-1.10 0.45
ST-max adjusted 1.14 0.99-1.33 0.07
Conclusion In summary, we found a statistically
significant association between periodontitis and
the presence of CHD, even after controlling for a
variety of potential confounders. Microbiological
parameters, like total periodontal pathogen
burden and especially the amount of
Actinobacillus actinomycetemcomitans in the
periodontal pockets seem to be of greater
importance as potential risk factors for CHD than
the clinical parameter CPITN.
adjusted for age, gender, body mass index,
smoking, alcohol consumption, diabetes,
hypertension, hyperlipoteinemia, school
education, physical activity, and statin intake
for an increase in mean CPITN of 1 unit and an
increase in ST-max of 1 mm