Periodontal infections cause changes in traditional and novel cardiovascular risk factors: Results from a randomized controlled clinical trial

• Published in: The American heart journal 2006-05, Vol.151 (5), p.977-984
• Main Authors: D'Aiuto, Francesco, Parkar, Mohamed, Nibali, Luigi, Suvan, Jean, Lessem, Jan, Tonetti, Maurizio S.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Antibiotics; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Blood Pressure; Body mass index; Cardiology. Vascular system; Cardiovascular Diseases - etiology; Cardiovascular Diseases - prevention & control; Clinical trials; Dental Scaling; Family medical history; Female; Humans; Infection - complications; Infection - drug therapy; Infection - therapy; Infections; Inflammation - blood; Lipids; Lipids - blood; Male; Medical sciences; Middle Aged; Patients; Periodontal Diseases - complications; Periodontal Diseases - drug therapy; Periodontal Diseases - therapy; Pilot Projects; Risk Factors; Root Planing; Software; Variance analysis
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2005.06.018

Chronic infections, such as periodontitis, are associated with increased risk of systemic diseases driven by a persistent low-grade systemic inflammation and metabolic changes. Severity of periodontitis has also been associated with increased systolic blood pressure (BP). However, the issue remains poorly investigated. We aimed to estimate the effect of periodontal therapy on traditional and novel cardiovascular risk factors in systemically healthy individuals who have periodontitis. We enrolled 40 otherwise healthy patients with severe chronic generalized periodontitis in a 6-month pilot intervention trial. Individuals were randomized either to a standard course of periodontal therapy (subgingival scaling and root planing) or an intensive one (including the adjunctive use of a locally delivered antimicrobial, IPT). Compared to control, IPT produced significant reductions in a cluster of inflammatory markers at 1 ( P = .0406) and 2 ( P = .0060) months together with an improvement in lipid markers at 2 ( P = .0320) and 6 ( P = .0432) months after therapy. Intensive periodontal therapy produced greater reductions in IL-6 at 1 (0.4 ± 0.2 ng/L difference, 95% CI 0.03-0.9, P = .0284) and 2 months (0.3 ± 0.2 ng/L difference, 95% CI 0.1-0.8, P = .0284), together with decreases in C-reactive protein (0.4 ± 0.2 mg/L difference, 95% CI 0.01-0.8, P = .0438) and total cholesterol (0.3 ± 0.1 mmol/L difference, 95% CI 0.04-0.6, P = .0254). Moreover, a 7 ± 3-mm Hg decrease in systolic BP was observed at 2 months in the IPT group (95% CI 1-12, P = .0211), and this difference was greater in current smokers (14 ± 5 mm Hg 95% CI 3-25, P = 0.0124). Intensive periodontal therapy subjects exhibited a 1.53% ± 1.20% (95% CI 1.05-2.24, P = .0290) and 2.00% ± 1.42% (95% CI 0.98-4.09, P = .0568) decreases in cardiovascular risk scores (Framingham) at 2 and 6 months, respectively, when compared to those in the standard group. Our findings suggest that intensive periodontal treatment reduces systemic inflammatory markers and systolic BP, and improves lipid profiles with subsequent changes in cardiovascular risk when compared to standard therapy.