title: Relationship between periodontal disease, Porphyromonas gingivalis, peripheral vascular resistance markers and coronary artery disease in Asian Indians.
abstract: BACKGROUND
  A close association exists between oral health and cardiovascular disease. Periodontal disease induces early vascular changes while oral pathogens have been detected in sub gingival and atheromatous plaques. We examined the interrelationship between Periodontal disease, oral bacteria, surrogate sub-clinical markers and coronary artery disease (CAD) in a representative Asian Indian cohort.
  
  
  METHODS
  532 Gingivitis cases and 282 Periodontitis cases were assessed for early peripheral vascular changes, namely pulse wave velocity (PWV), arterial stiffness index (ASI) and ankle brachial index (ABI) using computerized oscillometry method. Relative quantitation (RQ) of Porphyromonas gingivalis (Pg) was estimated in saliva samples of 54 Periodontitis, 25 Gingivitis and 51 CAD cases (38 also had oral disease) by Taqman assay by amplifying pathogen-specific gene targets, 16srRNA and IktA, respectively, and 16s universal bacterial rRNA as endogenous control.
  
  
  RESULTS
  PWV and ASI were elevated in Periodontitis compared to Gingivitis cases (p<0.0001) and in those with diabetes and hypertension. Cases with Periodontitis showed higher mean expression of Pg than Gingivitis (0.37±0.05 versus 0.15±0.04, p<0.0001), while CAD patients with oral disease (N=38) showed lower mean Pg expression than those without oral disease (N=13) (0.712±0.119 versus 1.526±0.257, p=0.008). Higher Pg expression was recorded in subjects with diabetes and hypertension.
  
  
  CONCLUSIONS
  Oral disease induces early changes in the peripheral blood vessels. Further, common presence of Pg in subjects with oral disease, in those with established cardiovascular risk factors and in patients with symptomatic CAD reflects the importance of oral hygiene in the development of Coronary Artery Disease in Asian Indians.
authors.affiliation: Clinical Research Unit, Thrombosis Research Institute, India. Jayashreeshanker@triindia.org.in
authors.forename: Jayashree
authors.initials: J
authors.lastname: Shanker
authors.forename: Priyanka
authors.initials: P
authors.lastname: Setty
authors.forename: Prathima
authors.initials: P
authors.lastname: Arvind
authors.forename: Jiny
authors.initials: J
authors.lastname: Nair
authors.forename: Dhanalakshmi
authors.initials: D
authors.lastname: Bhasker
authors.forename: G
authors.initials: G
authors.lastname: Balakrishna
authors.forename: Vijay V
authors.initials: VV
authors.lastname: Kakkar
mesh_terms: D000328:Adult; D016866:Bacteroidaceae Infections / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000453:epidemiology*; D005260:Female; D005891:Gingivitis / Q000150:complications / Q000382:microbiology / Q000503:physiopathology; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology*; D010510:Periodontal Diseases / Q000150:complications* / Q000382:microbiology* / Q000503:physiopathology; D016966:Porphyromonas gingivalis / Q000302:isolation & purification*; D012307:Risk Factors; D014655:Vascular Resistance
keywords: Apoe(shl); Apolipoprotein-E-deficient spontaneously hyperlipidemic mice; CAD; ICMR; Indian Council of Medical Research; OMP; Periodontal disease; Porphyromonas gingivalis; RQ; Relative Quantitation; Tanerella forsynthia; Tf; arterial stiffness; conventional risk factors; coronary artery disease; outer membrane protein; pulse wave velocity