liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Periodontitis and coronary artery disease: Studies on the association between periodontitis and coronary artery disease
Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Periodontitis and coronary artery disease (CAD) are highly prevalent in Sweden’s population; both diseases have complicated pathogeneses and clinical manifestations due to immune-system triggered inflammation. Research in recent years reported that inflammation is a significant active participant in many chronic diseases. The literature described a CAD-periodontitis association, but underlying mechanisms are not fully understood. It is important to acquire knowledge about how periodontitis might influence CAD, which is one of the major causes of illness and death in western countries. Because periodontitis can be treated, this knowledge, when complemented with more knowledge about the CAD-periodontitis association, could lead to CAD prevention.

The overall aim of studies reported in this thesis were to investigate the CAD-periodontitis association, and specifically, to: (i) compare periodontal conditions in patients with CAD and subjects without a history of CAD; (ii) study whether or not periodontal status influences outcomes in known CAD over an 8-year period; (iii) study whether or not concentrations and biological activity of hepatocyte growth factor (HGF) in serum from patients with severe CAD are different – depending on whether or not the subjects had periodontitis; and (iv) study concentrations and biological activity of hepatocyte growth factor in serum, saliva, and gingival crevicular fluid in healthy subjects with or without periodontitis. Here is a brief summary:

In study I, 161 patients with CAD and 162 controls were compared regarding periodontal disease prevalence and severity. CAD patients had significant coronary stenosis and underwent percutaneous coronary intervention (PCI) or coronary artery by-pass grafts (CABG). Healthy controls were recruited from Sweden’s population database. Twenty-five per cent of the CAD patients had severe periodontitis, compared to 8% of the controls. In a multiple logistic regression analysis (controlled for age and smoking), severe periodontitis indicated an odds ratio of 5.74 (2.07–15.90) for CAD.

Study II: Periodontal status was re-examined in 126 CAD patients and 121 controls from the initial sample after 8 years. Periodontal status at baseline was analysed and related to CAD endpoints (i.e., myocardial infarction, new PCI or CABG or death due to CAD) recorded from patients’ medical records and from the death index maintained by the National Board of Health and Welfare. The difference in periodontitis prevalence and severity between the two groups remained unchanged during the 8-year follow up. No significant differences were found regarding CAD endpoints during follow-up in relation to baseline periodontal status in the CAD-patient group.

In study III, higher HGF serum concentrations (p<0.001) were found in CAD patients, compared to healthy blood donors, which reflects chronic inflammation. In CAD patients without periodontitis, HGF concentrations increased significantly 24 hours after PCI – in parallel with increased HGF biological activity. In CAD patients with periodontitis, only small fluctuations were seen in HGF values, i.e., concentration and biological activity. HGF biological activity was temporarily elevated after PCI but only in patients without periodontitis. Thus chronic inflammation related to periodontitis might reduce HGF biological activity.

In study IV, HGF concentration and biological activity in saliva, in gingival crevicular fluid (GCF), and serum were compared between 30 generally healthy subjects with severe untreated periodontitis and 30 healthy subjects without periodontitis. Compared to periodontally healthy controls, periodontal patients showed higher HGF concentrations in saliva p<0.001, gingival crevicular fluid p<0.0001, and in serum p<0.001. HGF biological activity (measured as the binding affinity to its HSPG and c-MET receptors) was significantly reduced in saliva (p<0.0001) and GCF samples (p<0.0001 for HSPG and p<0.01 for c-MET) from periodontitis patients. The only significant difference in serum samples was an increases in c-MET binding three minutes after subgingival debridement in periodontitis patients (p<0.05), which might reflect that patients had active bursts of periodontitis.

In conclusion, CAD patients more often showed severe periodontitis but there were no differences in CAD endpoints during the eight-year follow-up in relation to baseline periodontal status. Periodontitis seems to influence HGF concentration and biological activity in CAD patients, but studies on factors that cause lower HGF biological activity are necessary – to find out if periodontal treatment influences HGF biological activity. Healthy periodontitis patients had higher HGF concentrations locally and systemically, but biological activity was reduced. This might indicate that periodontitis can influence wound healing and tissue repair in other body parts.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. , 84 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1343
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-86213ISBN: 978-91-7519-748-7 (print)OAI: oai:DiVA.org:liu-86213DiVA: diva2:575726
Public defence
2013-02-01, Berzeliussalen, Campus US, Linköpings universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Note

The ISBN 987‐91‐7519‐748‐7 is incorrect. Correct ISBN is 978‐91‐7519‐748‐7.

Available from: 2012-12-11 Created: 2012-12-11 Last updated: 2017-04-15Bibliographically approved
List of papers
1. Periodontal conditions in patients with coronary heart disease: A case-control study
Open this publication in new window or tab >>Periodontal conditions in patients with coronary heart disease: A case-control study
Show others...
2008 (English)In: Journal of Clinical Periodontology, ISSN 0303-6979, E-ISSN 1600-051X, Vol. 35, no 3, 199-205 p.Article in journal (Refereed) Published
Abstract [en]

Aim: This study examined periodontal conditions in patients with coronary heart disease (CHD) and subjects with no history of CHD. Material and Methods: Participants were 161 patients (40-75) with severe angina pectoris (diagnosed as CHD by coronary angiography) who subsequently underwent percutaneous coronary intervention and 162 control subjects with no history of CHD. Periodontal status was recorded. Bone loss was determined on radiographs. Periodontal disease experience was classified into five groups according to Hugoson & Jordan. Results: Periodontal disease experience groups 4 and 5 were more common in the CHD group (25%) compared with the control group (8%). The mean bone level (the distance from the CEJ to the most coronal level of the alveolar bone) was 3.0±1.0 mm in CHD subjects and 2.6±0.8 mm in controls. CHD patients had significantly lower numbers of natural teeth, higher numbers of periodontal pockets 4-6-mm and higher bleeding on probing (%). In a stepwise regression analysis, the factor periodontal disease experience groups 4+5 gave an odds ratio of 5.74 (2.07-15.90) for having CHD after controlling for smoking and age. Conclusion: Severe periodontal disease expressed by several clinical and radiographic parameters was more prevalent among subjects with CHD than among controls. Analysis, the factor periodontal disease experience groups 4+5 gave an odds ratio of 5.74 (2.07-15.90) for having CHD after controlling for smoking and age. © 2008 Blackwell Munksgaard.

Keyword
Alveolar bone level, Coronary heart disease, Number of teeth, Periodontal disease
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-47655 (URN)10.1111/j.1600-051X.2007.01185.x (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13
2. Periodontal conditions in patients with coronary heart disease: A case-control study
Open this publication in new window or tab >>Periodontal conditions in patients with coronary heart disease: A case-control study
2012 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Aim: To study if CAD-related morbidity and mortality (endpoints; myocardial infarction, coronary artery revascularization or CAD-related death) during 8-years follow was related to baseline periodontal status.

Material and methods: In 2003, periodontal status was examined in 161 CAD patients who underwent percutaneous coronary intervention or coronary artery by-pass graft due to significant stenosis in the coronary arteries, and in 162 control subjects without CAD history. Eight years later, 126 CAD patients and 121 controls were periodontally re-examined. The groups were classified into five categories as per periodontal disease experience (Hugoson & Jordan 1982). Cause of death due to CAD was obtained from Sweden’s death register. Myocardial infarction and coronary artery revascularization procedures were confirmed by review of medical records.

Results: No significant differences were found among CAD patients with / without CAD related endpoints and periodontal disease experience group (p=0.7). Significant differences were found at the final examination in periodontitis prevalence and severity (p=0.001), number of teeth (p=0.006), pockets 4-6 mm (p=0.016), bleeding on probing (p=0.001) and radiographic bone level between (p=0.042) between CAD-patients and controls.

Conclusion: The study results did not show a significant association between CAD outcomes after 8 years and periodontal status at baseline. Further long-term prospective studies are needed to show whether periodontitis can be considered a risk or prognostic factor for CAD.

Keyword
coronary artery, periodontitis, alveolar bone level
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86205 (URN)
Available from: 2012-12-11 Created: 2012-12-11 Last updated: 2012-12-11Bibliographically approved
3. Hepatocyte growth factor in patients with coronary artery disease and its relation to periodontal condition
Open this publication in new window or tab >>Hepatocyte growth factor in patients with coronary artery disease and its relation to periodontal condition
Show others...
2012 (English)In: Results in Immunology, ISSN 2211-2839, Vol. 2, 7-12 p.Article in journal (Refereed) Published
Abstract [en]

Hepatocyte growth factor (HGF) is an angiogenic, cardioprotective factor important for tissue and vascular repair. High levels of HGF are associated with chronic inflammatory diseases, such as coronary artery disease (CAD) and periodontitis, and are suggested as a marker of the ongoing atherosclerotic event in patients with CAD. Periodontal disease is more prevalent among patients with CAD than among healthy people. Recent studies indicate a reduced biological activity of HGF in different chronic inflammatory conditions. Biologically active HGF has high affinity to heparan sulfate proteoglycan (HSPG) on cell-membrane and extracellular matrix. The aim of the study was to investigate the serum concentration and the biological activity of HGF with ELISA and surface plasmon resonance (SPR), respectively, before and at various time points after percutaneous coronary intervention (PCI) in patients with CAD, and to examine the relationship with periodontal condition. The periodontal status of the CAD patients was examined, and the presence of P. gingivalis in periodontal pockets was analyzed with PCR. The HGF concentration was significantly higher, at all time-points, in patients with CAD compared to the age-matched controls (P< 0.001), but was independent of periodontal status. The HGF concentration and the affinity to HSPG adversely fluctuated over time, and the biological activity increased one month after intervention in patients without periodontitis. We conclude that elevated concentration of HGF but with reduced biological activity might indicate a chronic inflammatory profile in patients with CAD and periodontitis.

Place, publisher, year, edition, pages
Elsevier, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86207 (URN)10.1016/j.rinim.2011.12.002 (DOI)
Available from: 2012-12-11 Created: 2012-12-11 Last updated: 2014-09-10
4. High concentrations of hepatocyte growth factor but low biological activity in patients with periodontitis
Open this publication in new window or tab >>High concentrations of hepatocyte growth factor but low biological activity in patients with periodontitis
Show others...
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: High levels of hepatocyte growth factor (HGF), a healing factor with regenerative and cytoprotective effects, has been associated to inflammatory diseases including periodontitis. To induce cellular responses, biologic active HGF requires binding to its receptor c-Met and the co-receptor heparan sulphate proteoglycan (HSPG) on cell membranes and extracellular matrix. The aim of this study was to investigate the concentration and the biological activity of HGF and the relationship with subgingival microbiota in medically healthy subject with / without periodontitis.

Methods: Saliva, gingival crevicular fluid (GCF) and blood samples from thirty patients with severe periodontitis and thirty periodontally healthy controls were analysed for the concentration of HGF and the binding affinity to HSPG and c-Met, using ELISA and surface plasmon resonance (SPR). Subgingival plaque were analysed for the presence of 18 bacterial species.

Results: Compared to controls, patients with periodontitis showed higher concentrations of HGF in all three locations (P<0.001), however the binding affinity to HSPG and c-Met were markedly reduced in GCF and in saliva (P<0.002). The patients had higher prevalence of periodontal related bacterial species.

Conclusion: The increased concentration of HGF in GCF and saliva in patients with severe periodontitis was also reflected in the circulation indicating a systemic effect by periodontitis. However, the biological activity of HGF at local sites of inflammation was reduced. A loss of function of healing factors such as HGF may be one important mechanism in the dominant degenerative processes in periodontally susceptible subjects.

Keyword
Hepatocyte growth factor; periodontal disease; saliva; GCF; serum; microbiology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86212 (URN)
Available from: 2012-12-11 Created: 2012-12-11 Last updated: 2012-12-11Bibliographically approved

Open Access in DiVA

Periodontitis and coronary artery disease: Studies on the association between periodontitis and coronary artery disease(806 kB)1590 downloads
File information
File name FULLTEXT01.pdfFile size 806 kBChecksum SHA-512
817e3eb929dc27328d4d0315c13fb4334b15bdb929021601dc271ffea6a99bfd9fde8e2f739f0957aea71969fb743736d6d8b6a34ea28a321bcd4686b5bfe258
Type fulltextMimetype application/pdf
omslag(110 kB)45 downloads
File information
File name COVER01.pdfFile size 110 kBChecksum SHA-512
a66dd89522262a47fdd63f95235c87e4961a56ccb9dab6db7be01427cbeca5a838db2700afcd934352ca92f328b292c46442274c51f8e4e0d237c18ceff614a7
Type coverMimetype application/pdf

Authority records BETA

Starkhammar Johansson, Carin

Search in DiVA

By author/editor
Starkhammar Johansson, Carin
By organisation
CardiologyFaculty of Health Sciences
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 1590 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 1030 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf