Treatment of periodontitis and endothelial function

被引:961
作者
Tonetti, Maurizio S. [1 ]
D'Aiuto, Francesco
Nibali, Luigi
Donald, Ann
Storry, Clare
Parkar, Mohamed
Suvan, Jean
Hingorani, Aroon D.
Vallance, Patrick
Deanfield, John
机构
[1] Univ Connecticut, Ctr Hlth, Dept Oral Hlth & Diagnost Sci, Farmington, CT 06032 USA
[2] UCL, Eastman Dent Inst & Hosp, Periodontol Unit, London, England
[3] UCL, Ctr Clin Pharmacol, London, England
[4] UCL, Vasc Physiol Unit, London, England
[5] Great Ormond St Hosp Sick Children, London WC1N 3JH, England
关键词
D O I
10.1056/NEJMoa063186
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Systemic inflammation may impair vascular function, and epidemiologic data suggest a possible link between periodontitis and cardiovascular disease. METHODS: We randomly assigned 120 patients with severe periodontitis to community-based periodontal care (59 patients) or intensive periodontal treatment (61). Endothelial function, as assessed by measurement of the diameter of the brachial artery during flow (flow-mediated dilatation), and inflammatory biomarkers and markers of coagulation and endothelial activation were evaluated before treatment and 1, 7, 30, 60, and 180 days after treatment. RESULTS: Twenty-four hours after treatment, flow-mediated dilatation was significantly lower in the intensive-treatment group than in the control-treatment group (absolute difference, 1.4%; 95% confidence interval [CI], 0.5 to 2.3; P=0.002), and levels of C-reactive protein, interleukin-6, and the endothelial-activation markers soluble E-selectin and von Willebrand factor were significantly higher (P<0.05 for all comparisons). However, flow-mediated dilatation was greater and the plasma levels of soluble E-selectin were lower in the intensive-treatment group than in the control-treatment group 60 days after therapy (absolute difference in flow-mediated dilatation, 0.9%; 95% CI, 0.1 to 1.7; P=0.02) and 180 days after therapy (difference, 2.0%; 95% CI, 1.2 to 2.8; P<0.001). The degree of improvement was associated with improvement in measures of periodontal disease (r=0.29 by Spearman rank correlation, P=0.003). There were no serious adverse effects in either of the two groups, and no cardiovascular events occurred. CONCLUSIONS: Intensive periodontal treatment resulted in acute, short-term systemic inflammation and endothelial dysfunction. However, 6 months after therapy, the benefits in oral health were associated with improvement in endothelial function.
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页码:911 / 920
页数:10
相关论文
共 38 条
[1]   Treatment allocation by minimisation [J].
Altman, DG ;
Bland, JM .
BRITISH MEDICAL JOURNAL, 2005, 330 (7495) :843-843
[2]   Periodontal disease is associated with brachial artery endothelial dysfunction and systemic inflammation [J].
Amar, S ;
Gokce, N ;
Morgan, S ;
Loukideli, M ;
Van Dyke, TE ;
Vita, JA .
ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 2003, 23 (07) :1245-1249
[3]  
Bacon P. A., 2002, Autoimmunity Reviews, V1, P338, DOI 10.1016/S1568-9972(02)00100-3
[4]   Relationship of periodontal disease to carotid artery intima-media wall thickness - The atherosclerosis risk in communities (ARIC) study [J].
Beck, JD ;
Elter, JR ;
Heiss, G ;
Couper, D ;
Mauriello, SM ;
Offenbacher, S .
ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 2001, 21 (11) :1816-1822
[5]   Endothelial function and dysfunction. Part II: Association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension [J].
Brunner, H ;
Cockcroft, JR ;
Deanfield, J ;
Donald, A ;
Ferrannini, E ;
Halcox, J ;
Kiowski, W ;
Luscher, TF ;
Mancia, G ;
Natali, A ;
Oliver, JJ ;
Pessina, AC ;
Rizzoni, D ;
Rossi, GP ;
Salvetti, A ;
Spieker, LE ;
Taddei, S ;
Webb, DJ .
JOURNAL OF HYPERTENSION, 2005, 23 (02) :233-246
[6]   Endothelial dysfunction in childhood infection [J].
Charakida, M ;
Donald, AE ;
Terese, M ;
Leary, S ;
Halcox, JP ;
Ness, A ;
Smith, GD ;
Golding, J ;
Friberg, P ;
Klein, NJ ;
Deanfield, JE .
CIRCULATION, 2005, 111 (13) :1660-1665
[7]   Short-term effects of intensive periodontal therapy on serum inflammatory markers and cholesterol [J].
D'Aiuto, F ;
Nibali, L ;
Parkar, M ;
Suvan, J ;
Tonetti, MS .
JOURNAL OF DENTAL RESEARCH, 2005, 84 (03) :269-273
[8]   Periodontitis and systemic inflammation: Control of the local infection is associated with a reduction in serum inflammatory markers [J].
D'Aiuto, F ;
Parkar, M ;
Andreou, G ;
Suvan, J ;
Brett, PM ;
Ready, D ;
Tonetti, MS .
JOURNAL OF DENTAL RESEARCH, 2004, 83 (02) :156-160
[9]   Periodontal infections cause changes in traditional and novel cardiovascular risk factors: Results from a randomized controlled clinical trial [J].
D'Aiuto, Francesco ;
Parkar, Mohamed ;
Nibali, Luigi ;
Suvan, Jean ;
Lessem, Jan ;
Tonetti, Maurizio S. .
AMERICAN HEART JOURNAL, 2006, 151 (05) :977-984
[10]   Periodontal microbiota and carotid intima-media thickness - The Oral Infections and Vascular Disease Epidemiology Study (INVEST) [J].
Desvarieux, M ;
Demmer, RT ;
Rundek, T ;
Boden-Albala, B ;
Jacobs, DR ;
Sacco, RL ;
Papapanou, PN .
CIRCULATION, 2005, 111 (05) :576-582