title: Endotoxin levels are associated with high-density lipoprotein, triglycerides, and troponin in patients with acute coronary syndrome and angina: possible contributions from periodontal sources.
abstract: BACKGROUND
  Recent studies have reported an association between poor dental health and acute coronary syndrome (ACS). The purpose of this study was to correlate the presence of periodontitis with serum endotoxin/lipopolysaccharides (LPS), lipid profiles, troponin, and immunoglobulin G (IgG) antibody to Porphyromonas gingivalis in control patients or patients with ACS or angina at the time of hospital admission.
  
  
  METHODS
  Blood samples from 194 subjects presenting with ACS, angina, or non-cardiac chest pain were analyzed for endotoxin/LPS (Limulus amebocyte lysate assay), lipid profile, troponin, and IgG antibody to P. gingivalis. Data were collected from hospital charts and dental records, and health questionnaire responses.
  
  
  RESULTS
  Subjects with ACS or angina were more likely to have poor oral care, fewer remaining teeth, and increased alveolar radiographic bone loss compared to subjects with chest pain. In all subjects, endotoxin/LPS and IgG antibody to P. gingivalis tended to increase in association with increased radiographic bone loss. Endotoxin/LPS increased directly with triglyceride and troponin levels (P = 0.04 and P = 0.006, respectively) and inversely with high-density lipoprotein (HDL) levels (P = 0.002). IgG antibody to P. gingivalis levels was directly correlated with very low-density lipoprotein (P = 0.03) and triglycerides (P = 0.06) and inversely with low-density lipoprotein (P = 0.01).
  
  
  CONCLUSIONS
  Results showed more alveolar bone loss in patients with cardiac disease than in patients without cardiac disease, but there was no difference between the groups in the serum levels of endotoxin/LPS or IgG antibody to P. gingivalis. However, there were associations between endotoxin/LPS and levels of serum triglycerides, troponin, and HDL.
authors.affiliation: Department of Periodontology, New Jersey Dental School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07930, USA. drgoteiner@yahoo.com
authors.forename: David
authors.initials: D
authors.lastname: Goteiner
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Craig
authors.forename: Robert
authors.initials: R
authors.lastname: Ashmen
authors.forename: Malvin N
authors.initials: MN
authors.lastname: Janal
authors.forename: Barnet
authors.initials: B
authors.lastname: Eskin
authors.forename: Neal
authors.initials: N
authors.lastname: Lehrman
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications; D016301:Alveolar Bone Loss / Q000097:blood / Q000150:complications; D000787:Angina Pectoris / Q000097:blood* / Q000150:complications; D000907:Antibodies, Bacterial / Q000097:blood; D002637:Chest Pain / Q000097:blood / Q000150:complications; D002784:Cholesterol / Q000097:blood; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D008070:Lipopolysaccharides / Q000097:blood; D008075:Lipoproteins, HDL / Q000097:blood*; D008077:Lipoproteins, LDL / Q000097:blood; D008079:Lipoproteins, VLDL / Q000097:blood; D008297:Male; D010518:Periodontitis / Q000097:blood* / Q000150:complications; D016966:Porphyromonas gingivalis / Q000276:immunology; D016388:Tooth Loss / Q000097:blood / Q000150:complications; D014280:Triglycerides / Q000097:blood*; D014336:Troponin / Q000097:blood*
chemical_list: D000907:Antibodies, Bacterial; D004731:Endotoxins; D007074:Immunoglobulin G; D008070:Lipopolysaccharides; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D008079:Lipoproteins, VLDL; D014280:Triglycerides; D014336:Troponin; D002784:Cholesterol