title: Clarithromycin reduces recurrent cardiovascular events in subjects without periodontitis.
abstract: Inflammation leading to acute coronary syndrome may be triggered by bacteria causing periodontal infection. We investigated if recurrence of cardiovascular events in unstable coronary patients are associated with periodontitis or microbiological/serological markers of it. Periodontitis-related parameters of 141 patients with acute non-Q-wave infarction or unstable angina pectoris, who participated in a double-blind, placebo-controlled study with clarithromycin for 3 months, were adjusted to the occurrence of a recurrent cardiovascular event during a follow-up period (average 519 days). In the age group under 65 years the patients with periodontitis had a univariate odds ratios (OR) 95% confidence intervals (95% CI) of 5.0 (1.02-24.55) for a recurrent cardiovascular event in comparison with patients without periodontitis. Dental status correlated positively with serum lipopolysaccharide concentrations and combined IgG antibody response to Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. The end point frequency did not differ between clarithromycin and placebo groups in bacterium-positive, seropositive, or periodontitis patients. Fewer end points in clarithromycin group were seen in bacterium-negative, seronegative, edentulous, and non-periodontitis patients. Periodontitis and edentulousness are associated with recurrent cardiovascular events, especially in younger patients. Long-term clarithromycin therapy seems to be beneficial in prevention of recurrent cardiovascular events in non-periodontitis but not in periodontitis patients.
authors.affiliation: Institute of Dentistry, University of Helsinki, and Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Susanna
authors.initials: S
authors.lastname: Paju
authors.forename: Pirkko J
authors.initials: PJ
authors.lastname: Pussinen
authors.forename: Juha
authors.initials: J
authors.lastname: Sinisalo
authors.forename: Kimmo
authors.initials: K
authors.lastname: Mattila
authors.forename: Başak
authors.initials: B
authors.lastname: Doğan
authors.forename: Jari
authors.initials: J
authors.lastname: Ahlberg
authors.forename: Ville
authors.initials: V
authors.lastname: Valtonen
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Sirkka
authors.initials: S
authors.lastname: Asikainen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016976:Aggregatibacter actinomycetemcomitans / Q000276:immunology; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000209:etiology*; D017291:Clarithromycin / Q000627:therapeutic use*; D023381:Endpoint Determination; D005260:Female; D005387:Finland; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D008070:Lipopolysaccharides / Q000097:blood; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000150:complications* / Q000276:immunology / Q000382:microbiology; D016966:Porphyromonas gingivalis / Q000276:immunology; D012044:Regression Analysis; D055502:Secondary Prevention; D018709:Statistics, Nonparametric
chemical_list: D007074:Immunoglobulin G; D008070:Lipopolysaccharides; D017291:Clarithromycin