PERIODONTAL-DISEASE AND CARDIOVASCULAR-DISEASE

IT IS OUR CENTRAL HYPOTHESIS that periodontal diseases, which are chro nic Gramnegative infections, represent a previously unrecognized risk factor for atherosclerosis and thromboembolic events. Previous studies have demonstrated an association between periodontal disease severity and risk of coronary heart disease and stroke, We hypothesize that th is association may be due to an underlying inflammatory response trait , which places an individual at high risk for developing both periodon tal disease and atherosclerosis. We further suggest that periodontal d isease, once established, provides a biological burden of endotoxin (l ipopolysaccharide) and inflammatory cytokines (especially TxA(2), IL-1 beta, PGE(2), and TNF-alpha) which serve to initiate and exacerbate a therogenesis and thromboembolic events. A cohort study was conducted u sing combined data from the Normative Aging Study and the Dental Longi tudinal Study sponsored by the United States Department of Veterans Af fairs, Mean bone loss scores and worst probing pocket depth scores per tooth were measured on 1,147 men during 1968 to 1971. Information gat hered during follow-up examinations showed that 207 men developed coro nary heart disease (CHD), 59 died of CHD, and 40 had strokes. Incidenc e odds ratios adjusted for established cardiovascular risk factors wer e 1.5, 1.9, and 2.8 for bone loss and total CHD, fatal CHD, and stroke , respectively. Levels of bone loss and cumulative incidence of total CHD and fatal CHD indicated a biologic gradient between severity of ex posure and occurrence of disease.