Periodontal disease and atherosclerotic cardiovascular disease: Confounding effects or epiphenomenon?

Recent evidence suggests that periodontal disease may predispose to atheros clerotic cardiovascular disease. Data support mechanisms of host-derived lo cal and systemic proinflammatory responses similar to atherosclerosis, cons isting of monocytic-derived cytokines and other inflammatory mediators, whi ch are induced by periodontal pathogens and its endotoxin, lipopolysacchari de. These mechanisms may contribute to the start of vascular endothelial dy sfunction and further sequelae leading to atherosclerosis. Experimental evi dence and biologic plausibility appear to support this proposal. However, c linical evidence from a MEDLINE search from January 1966-December 1999 prop osed a weak or no correlation primarily due to confounding factors. The aim of care is to reduce vulnerable pathogens from the infected periodontium b y standard treatment; however, new approaches appear promising. Increased a wareness of a potential link among infective agents, immunoinflammatory pro cesses, and atherosclerosis may clarify clinical implications.