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Article: Periodontitis and atherosclerotic cardiovascular disease: Consensus report of the Joint EFP/ AAP Workshop on Periodontitis and Systemic Diseases

TitlePeriodontitis and atherosclerotic cardiovascular disease: Consensus report of the Joint EFP/ AAP Workshop on Periodontitis and Systemic Diseases
Authors
KeywordsEpidemiology
Stroke
Periodontitis
Myocardial infarction
Atherosclerosis
Clinical trials
Cardiovascular diseases
Bacteremia
C-reactive protein
Periodontal diseases
Inflammation
Issue Date2013
Citation
Journal of Periodontology, 2013, v. 84, n. 4, p. S24-S29 How to Cite?
Abstract© 2013 European Federation of Periodontology and American Academy of Periodontology.Background: This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue. Aims: This report examined biological plausibility, epidemiology and early results from intervention trials. Plausibility: Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation and exacerbation. Epidemiology: In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for ACVD was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective. Intervention: There is moderate evidence that periodontal treatment: (i) reduces systemic inflammation as evidenced by reduction in C-reactive protein (CRP) and improvement of both clinical and surrogate measures of endothelial function; but (ii) there is no effect on lipid profiles - supporting specificity. Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy. The available evidence is consistent and speaks for a contributory role of periodontitis to ACVD. There are no periodontal intervention studies on primary ACVD prevention and there is only one feasibility study on secondary ACVD prevention. Conclusions: It was concluded that: (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) while in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well-designed intervention trials on the impact of periodontal treatment on prevention of ACVD hard clinical outcomes are needed.
Persistent Identifierhttp://hdl.handle.net/10722/230947
ISSN
2015 Impact Factor: 2.844
2015 SCImago Journal Rankings: 1.070

 

DC FieldValueLanguage
dc.contributor.authorTonetti, Maurizio S.-
dc.contributor.authorVan Dyke, Thomas E.-
dc.contributor.authorBeck, James-
dc.contributor.authorBouchard, Philippe-
dc.contributor.authorCutler, Chris-
dc.contributor.authorD'Aiuto, Francesco-
dc.contributor.authorDietrich, Thomas-
dc.contributor.authorEke, Paul-
dc.contributor.authorGraziani, Filippo-
dc.contributor.authorGunsolley, John-
dc.contributor.authorHerrera, David-
dc.contributor.authorHart, Thomas-
dc.contributor.authorShearer, Barbara-
dc.contributor.authorJepsen, Søren-
dc.contributor.authorKantarci, Alpdogan-
dc.contributor.authorLoos, Bruno G.-
dc.contributor.authorProgulske-Fox, Ann-
dc.contributor.authorSchenkein, Harvey-
dc.contributor.authorRenvert, Stefan-
dc.contributor.authorWilliams, Ray-
dc.date.accessioned2016-09-01T06:07:13Z-
dc.date.available2016-09-01T06:07:13Z-
dc.date.issued2013-
dc.identifier.citationJournal of Periodontology, 2013, v. 84, n. 4, p. S24-S29-
dc.identifier.issn0022-3492-
dc.identifier.urihttp://hdl.handle.net/10722/230947-
dc.description.abstract© 2013 European Federation of Periodontology and American Academy of Periodontology.Background: This consensus report is concerned with the association between periodontitis and atherosclerotic cardiovascular disease (ACVD). Periodontitis is a chronic multifactorial inflammatory disease caused by microorganisms and characterized by progressive destruction of the tooth supporting apparatus leading to tooth loss; as such, it is a major public health issue. Aims: This report examined biological plausibility, epidemiology and early results from intervention trials. Plausibility: Periodontitis leads to entry of bacteria in the blood stream. The bacteria activate the host inflammatory response by multiple mechanisms. The host immune response favors atheroma formation, maturation and exacerbation. Epidemiology: In longitudinal studies assessing incident cardiovascular events, statistically significant excess risk for ACVD was reported in individuals with periodontitis. This was independent of established cardiovascular risk factors. The amount of the adjusted excess risk varies by type of cardiovascular outcome and across populations by age and gender. Given the high prevalence of periodontitis, even low to moderate excess risk is important from a public health perspective. Intervention: There is moderate evidence that periodontal treatment: (i) reduces systemic inflammation as evidenced by reduction in C-reactive protein (CRP) and improvement of both clinical and surrogate measures of endothelial function; but (ii) there is no effect on lipid profiles - supporting specificity. Limited evidence shows improvements in coagulation, biomarkers of endothelial cell activation, arterial blood pressure and subclinical atherosclerosis after periodontal therapy. The available evidence is consistent and speaks for a contributory role of periodontitis to ACVD. There are no periodontal intervention studies on primary ACVD prevention and there is only one feasibility study on secondary ACVD prevention. Conclusions: It was concluded that: (i) there is consistent and strong epidemiologic evidence that periodontitis imparts increased risk for future cardiovascular disease; and (ii) while in vitro, animal and clinical studies do support the interaction and biological mechanism, intervention trials to date are not adequate to draw further conclusions. Well-designed intervention trials on the impact of periodontal treatment on prevention of ACVD hard clinical outcomes are needed.-
dc.languageeng-
dc.relation.ispartofJournal of Periodontology-
dc.subjectEpidemiology-
dc.subjectStroke-
dc.subjectPeriodontitis-
dc.subjectMyocardial infarction-
dc.subjectAtherosclerosis-
dc.subjectClinical trials-
dc.subjectCardiovascular diseases-
dc.subjectBacteremia-
dc.subjectC-reactive protein-
dc.subjectPeriodontal diseases-
dc.subjectInflammation-
dc.titlePeriodontitis and atherosclerotic cardiovascular disease: Consensus report of the Joint EFP/ AAP Workshop on Periodontitis and Systemic Diseases-
dc.typeArticle-
dc.description.natureLink_to_subscribed_fulltext-
dc.identifier.doi10.1902/jop.2013.1340019-
dc.identifier.pmid23631582-
dc.identifier.scopuseid_2-s2.0-84893188376-
dc.identifier.volume84-
dc.identifier.issue4-
dc.identifier.spageS24-
dc.identifier.epageS29-

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