Periodontal Disease Linked to ASCVD due to shared pathways: Study

Periodontal disease (PD) is a
prevalent chronic infection of the gums and the surrounding bone seen in older
adults that begins with the accumulation of dental plaque leading to gingivitis.
Gingivitis, an inflammatory response can progress to PD potentially causing
bone loss and tooth damage due to deeper penetration of the bacteria. Risk factors
like smoking, diabetes, and poor oral hygiene many of which are also atherosclerotic
cardiovascular risk factors may worsen the progression of PD. Additionally, an
imbalance in oral flora (dysbiosis) can lead to bacteremia, the spread of
bacteria in the bloodstream, prompting systemic inflammation that might link PD
to ASCVD.

Mechanisms by which PD can lead
to ASCVD:

• Direct translocation of bacteria like
  porphyromonas gingivalis into the bloodstream or through inflammatory or immune
  responses can affect cardiovascular health as periodontal bacteria have also
  been detected in the atheromatous plaques.
• Triggering of immune responses or inflammatory
  diseases by bacteria causing PD like the P.gingivals can activate immune cells
  like macrophages, T-cells, and B-cells which are in turn linked to
  atherosclerosis progression.
• PD can lead to increased platelet activity which
  can in turn cause thrombus formation and transient ischemic attacks increasing
  the risk of atherosclerotic cardiovascular disease.
• Impaired endothelial function leading to reduced
  vascular flexibility and increased oxidative stress can be caused by
  periodontal disease. Improved endothelial health was seen due to improved periodontal
  condition.
• Diabetes, smoking, dyslipidemia, hypertension,
  obesity, and poor diet are some of the common and shared risk factors that can
  increase the risk of ASCVD in poor periodontal health.
• Shared inflammatory pathways and biomarkers suggest
  a strong biological link between PD and ASCVD.

Supporting Data:

Literature in the past has also
observed a positive association between PD and ASCVD with PD doubling the risk
of myocardial infarction, peripheral arterial disease, and ischemic stroke. Oral
health can have a long-term impact on vascular health as pediatric Oral
infections are linked to increased carotid artery thickness in adulthood.

Thus, the researchers highlight that
poor periodontal health can increase the risk of cardiovascular diseases. The
authors call for increased awareness and preventive measures, especially in
lower socio-economic areas where the risk of PD causing ASCVD is higher. Further
research is needed to justify the etiology and the potential benefits of
periodontal treatment in reducing cardiovascular diseases.

Further reading: Gianos E, Jackson EA, Tejpal A, et al. Oral health and atherosclerotic cardiovascular disease: A review. Am J Prev Cardiol. 2021;7:100179. Published 2021 Apr 5. doi:10.1016/j.ajpc.2021.100179