Periodontal disease in patients with acute myocardial infarction: prevalence and contribution to elevated C-reactive protein levels

Deliargyris, Efthymios N; Madianos, Phoebus N; Kadoma, Waka; Marron, Irene; Smith, Sidney C; Beck, James D; Offenbacher, Steven

doi:10.1016/j.ahj.2003.12.022

« Previous Next »American Heart Journal
Volume 147, Issue 6 , Pages 1005-1009, June 2004

Periodontal disease in patients with acute myocardial infarction: prevalence and contribution to elevated C-reactive protein levels

Efthymios N Deliargyris, MD
- Cardiology Section, Athens Medical Center, Athens, Greece
- Centers for Inflammatory Disorders and Oral and Systemic Diseases, Chapel Hill, NC, USA
- Reprint requests: Efthymios N. Deliargyris, MD, FACC, FSCAI, Cardiology Section—Athens Medical Center, Distomou 5-7, Marousi-Athens 15125, Greece.
Phoebus N Madianos, DDS, PhD
- Centers for Inflammatory Disorders and Oral and Systemic Diseases, Chapel Hill, NC, USA
- Deptartment of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
- Department of Periodontology, University of Athens School of Dentistry, Athens, Greece
Waka Kadoma, DDS
- Deptartment of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
Irene Marron, DDS
- Deptartment of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
Sidney C Smith Jr, MD
- Center for Cardiovascular Science and Medicine, University of North Carolina School of Medicine,Chapel Hill, NC, USA
James D Beck, PhD
- Centers for Inflammatory Disorders and Oral and Systemic Diseases, Chapel Hill, NC, USA
- Department of Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA
Steven Offenbacher, DDS, PhD
- Centers for Inflammatory Disorders and Oral and Systemic Diseases, Chapel Hill, NC, USA
- Deptartment of Periodontology, University of North Carolina School of Dentistry, Chapel Hill, NC, USA

Received 5 May 2003; accepted 31 December 2003.

Abstract

Background

Periodontal disease (PD) has been linked to adverse cardiovascular events, but the mechanism for this association is unknown. We hypothesized that PD is common in patients with acute myocardial infarction (AMI) and, when present, may result in an enhanced systemic inflammatory response with higher C-reactive protein (CRP) levels.

Methods

Periodontal examinations and serum high sensitivity CRP measurements were performed in 40 patients with AMI (11 women; mean age, 60 ± 15 years) during the index hospitalization. The control group comprised 40 sex and race frequency-matched, community volunteers (9 women; mean age, 64 ± 5 years) without known heart disease.

Results

Both the prevalence of PD and mean serum CRP levels were significantly higher in the patients with AMI than in the control subjects (48% vs 17%, P <.001 and 40.2 vs 7.9 mg/L, P <.001, respectively). Patients with AMI who had PD had significantly higher CRP levels than patients with AMI who did not have PD (50.7 vs 30.7 mg/L, P <.001). With linear regression analysis, a positive relationship was shown between the extent of PD and serum CRP levels, and with a multivariate regression model that included smoking, diabetes mellitus, infarct size and PD, PD emerged as a strong and independent predictor of elevated CRP levels (r² = 0.33, P = .004).

Conclusions

Periodontal disease is common in patients with AMI and is associated with an enhanced inflammatory response expressed by higher CRP levels. The association of PD with CRP levels in patients with AMI appears to be independent of other contributing factors.