title: Matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 in blood as markers for early atherosclerosis in subjects with chronic periodontitis.
abstract: OBJECTIVE
  An association has been found between periodontal disease and the development of atherosclerosis. We investigated the hypothesis that periodontal disease triggers the expression of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in blood. Increased levels of these parameters might then indicate early atherosclerosis.
  
  
  METHODS
  In this cross-sectional study, the material comprised 80 subjects with chronic periodontitis and 31 subjects with no periodontal disease. Sixteen years after diagnosis of periodontal disease ultrasonography revealed a statistically significant difference (p < 0.001) of carotid intima-media thickness between the subjects with chronic periodontitis and the periodontally healthy subjects. Matrix metalloproteinase-9 and TIMP-1 were analyzed from blood as periodontal and systemic inflammatory markers. The relationship between MMP-9, TIMP-1 and MMP-9/TIMP-1 as dependent variables and several independent variables (age, sex, smoking, education, body mass index, hypertension, periodontal disease and cholesterol) were analyzed in multiple logistic regression models to assess the value of the inflammatory markers in predicting carotid atherosclerosis.
  
  
  RESULTS
  Matrix metalloproteinase-9 and TIMP-1 were significantly higher in plasma from subjects with periodontal disease and atherosclerosis. Periodontal disease was identified as the principal independent predictor both for atherosclerosis (odds ratio 3.89 for increase in bilateral carotid intima-media thickness) and for increased MMP-9, TIMP-1 and MMP-9/TIMP-1 (odds ratio 2.58, 5.53 and 3.41, respectively). Classical atherosclerosis risk factors, such as increased total cholesterol, age and sex (women), were significant predictors in the model.
  
  
  CONCLUSIONS
  Matrix metalloproteinase-9, TIMP-1 and MMP-9/TIMP-1 in blood from subjects with periodontal disease could be useful laboratory markers for increased carotid artery intima-media thickness.
authors.affiliation: Institute of Odontology, Karolinska Institute, Huddinge, Sweden.
authors.forename: P-O
authors.initials: PO
authors.lastname: Söder
authors.forename: J H
authors.initials: JH
authors.lastname: Meurman
authors.forename: T
authors.initials: T
authors.lastname: Jogestrand
authors.forename: J
authors.initials: J
authors.lastname: Nowak
authors.forename: B
authors.initials: B
authors.lastname: Söder
mesh_terms: D000367:Age Factors; D050197:Atherosclerosis / Q000097:blood* / Q000000981:diagnostic imaging; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging; D002784:Cholesterol / Q000097:blood; D055113:Chronic Periodontitis / Q000097:blood*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000150:complications; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000097:blood*; D008875:Middle Aged; D010512:Periodontal Index; D012907:Smoking; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000097:blood*; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators; D019715:Tissue Inhibitor of Metalloproteinase-1; D002784:Cholesterol; D020780:Matrix Metalloproteinase 9