Gum disease higher in heart attack patients

November 11, 2000

Individuals who are having a heart attack are more likely to have serious inflammation of gum tissue known as periodontal disease than those with no known heart disease, according to a study presented today at the American Heart Association's Scientific Sessions 2000.

Researchers, led by Efthymios Deliargyris, M.D., studied 38 men and women as they were admitted to the hospital with a first heart attack, comparing them to 38 people in the community with no coronary artery disease that would predispose them to such an event.

Eighty-five percent of the heart attack patients had periodontal disease, compared to 29 percent of the control group, says Deliargyris.

Researchers believe that high blood levels of C-reactive protein (CRP) may be a link between the two conditions. CRP is a marker of inflammation found to be elevated in heart attack patients. Higher levels of CRP are thought to predict heart attack recurrence. Deliargyris' team found that individuals with both periodontal disease and a first heart attack had higher blood levels of CRP than those without periodontal disease.

In this study, the CRP reading was related to severity of periodontal disease: the worse the periodontal disease, the higher the CRP level.

"The link so far is indirect, but it is enough to question whether treating periodontal disease might lower the risk of a recurrent heart attack in people who have a history of heart attack," says Sidney C. Smith, M.D., co-author of the study and a professor of medicine and director of the Center for Cardiovascular Disease at the University of North Carolina at Chapel Hill.

The research may help provide possible new approaches to heart attack prevention, but further studies are still needed to understand the relationship between periodontal disease and heart disease, Smith says.

"It's not as simple as saying, 'If you don't floss your teeth you're going to have a heart attack,'" he cautions. "But it may be important to have regular dental check-ups to determine if a person has periodontal disease, because this may be an indication of a systemic problem."

The study raises the question of whether people with periodontal disease who experience heart attack have an underlying inherited, or genetic, characteristic that predisposes them to inflammatory disease, Smith says.

Deliargyris says they are embarking on two studies to pin down the association even further. One multi-center trial, which they hope to start soon, will enroll hundreds of patients to determine if treating those with periodontal disease has any impact on rates of cardiovascular disease.

In a smaller study at the University of North Carolina (UNC), patients will be treated for periodontal disease and have measurements of blood flow through an artery in the forearm recorded before and after treatment. Atherosclerosis begins with damage to the arterial endothelium, the inner protective lining of arteries of the heart. Studies have shown that the condition of the forearm endothelium is similar to that of the heart muscle itself.

The study raises the question of whether periodontal disease screening should become a routine part of assessing heart attack risk, whether first or recurrent. Smith says that although dentists are paying attention to this avenue of heart research, any such recommendations would be premature. "If such a screening were performed, what would we do with it?" he asks. "It's a little early. But we're beginning to think that way."
Other contributors are Irene Marron, D.D.S.; Waka Kadoma, D.D.S.; Phoebus Madianos, Ph.D., D.D.S.; James D. Beck, Ph.D.; and Steven Offenbacher, Ph.D., D.D.S.

American Heart Association

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