A common periodontal pathogen has an adverse association with both acute and stable coronary artery disease.
OBJECTIVE
The aim of this study was to investigate the association between angiographically verified coronary artery disease (CAD) and salivary levels of four major periodontal pathogens.


METHODS
The study population (n = 492) was composed of 179 (36.4%) patients with stable CAD, 166 (33.7%) with acute coronary syndrome (ACS), and 119 (24.2%) showing no pathological findings by coronary angiography. All patients were subjected to a detailed oral health examination. The saliva samples were analyzed for lipopolysaccharide activity as well as for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, and Tannerella forsythia by quantitative PCR. Serum antibodies levels against A. actinomycetemcomitans were analyzed.


RESULTS
The level of bacterial burden was linearly associated with alveolar bone loss (p < 0.001) and bleeding on probing (p = 0.015). The median salivary levels of A. actinomycetemcomitans in pathogen-positive patients were significantly higher in the "Stable CAD" (p = 0.014) and the "ACS" (p = 0.044) groups when compared to "No significant CAD" patients. In logistic regression models, a 10-fold increase in the salivary A. actinomycetemcomitans levels was associated with a risk for stable CAD and ACS with odds ratios (ORs) of 7.47 (95% confidence interval [CI]: 1.57-35.5, p = 0.012) and 4.31 (95% CI: 1.06-17.5, p = 0.041), respectively. The OR for the association of IgA-class antibody levels against A. actinomycetemcomitans with ACS risk was 3.13 (95% CI: 1.38-7.12, p = 0.006)/log(10) unit increase.


CONCLUSIONS
High salivary levels of A. actinomycetemcomitans and systemic exposure to the bacterium were associated with increased risk for CAD. These findings emphasize the importance of oral microbiota in cardiovascular risk assessment and therapeutics.
Institute of Dentistry, P.O. Box 63, Biomedicum 1, 00014, University of Helsinki, Helsinki, Finland. kati.hyvarinen@helsinki.fi
Kati
K
Hyvärinen
Päivi
P
Mäntylä
Kåre
K
Buhlin
Susanna
S
Paju
Markku S
MS
Nieminen
Juha
J
Sinisalo
Pirkko J
PJ
Pussinen
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000382:microbiology*; D000368:Aged; D016976:Aggregatibacter actinomycetemcomitans / Q000302:isolation & purification; D016301:Alveolar Bone Loss / Q000382:microbiology*; D000907:Antibodies, Bacterial / Q000097:blood; D058491:Bacterial Load; D041963:Bacteroidetes / Q000737:chemistry / Q000235:genetics / Q000302:isolation & purification*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000382:microbiology*; D003945:Diagnosis, Oral; D005260:Female; D005387:Finland; D006470:Hemorrhage; D006801:Humans; D008070:Lipopolysaccharides / Q000032:analysis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015661:Pasteurellaceae / Q000737:chemistry / Q000235:genetics / Q000302:isolation & purification*; D010510:Periodontal Diseases / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D016966:Porphyromonas gingivalis / Q000737:chemistry / Q000235:genetics / Q000302:isolation & purification*; D018713:Prevotella intermedia / Q000737:chemistry / Q000235:genetics / Q000302:isolation & purification*; D060888:Real-Time Polymerase Chain Reaction; D018570:Risk Assessment; D012307:Risk Factors; D012463:Saliva / Q000378:metabolism / Q000382:microbiology*; D012720:Severity of Illness Index
D000907:Antibodies, Bacterial; D008070:Lipopolysaccharides