Abstract
Cardiovascular diseases are the leading cause of morbidity and mortality worldwide. High blood pressure in particular, continues to increase throughout the global population at an increasingly fast pace. The relationship between arterial hypertension and periodontitis has been recently discussed in the context of its origins and implications. Particularly relevant is the role of the periodontal microbiome linked to persistent local and systemic inflammation, along with other risk factors and social determinants of health. The present protocol will investigate/assess the association between periodontal disease and its microbiome on the onset of hypertension, within a cohort from Mexico City. One thousand two hundred twelve participants will be studied during a 60-month period. Studies will include analysis of periodontal conditions, sampling and sequencing of the salivary and subgingival microbiome, interviews on nutritional and lifestyle habits, social determinants of health, blood pressure and anthropometric measurements. Statistical associations and several classic epidemiology and machine learning approaches will be performed to analyze the data. Implications for the generation of public policy—by early public health interventions or epidemiological surveillance approaches—and for the population empowerment—via the establishment of primary prevention recommendations, highlighting the relationship between oral and cardiovascular health—will be considered. This latter set of interventions will be supported by a carefully planned science communication and health promotion strategy. This study has been registered and approved by the Research and Ethics Committee of the School of Dentistry, Universidad Nacional Autónoma de México (CIE/0308/05/2019) and the National Institute of Genomic Medicine (CEI/2020/12). The umbrella cohort was approved by the Institutional Bioethics Committee of the National Institute of Cardiology-Ignacio Chavez (INC-ICh) under code 13-802.
Highlights
High blood pressure (HBP) is the leading risk factor for myocardial infarction, cerebrovascular events, atherosclerosis, aortic aneurysms, peripheral arterial disease, heart failure, and chronic kidney disease, among other ailments
The main objectives of this study are: (i) to identify the subgingival microbiome, as well as the factors associated with periodontitis, (ii) to quantify its association with the incidence of hypertension and (iii) to analyze the triple association between the oral subgingival microbiome, the presence and extent of periodontal disease, and the development of hypertension in people aged 20 years and over that will be followed for a period of 60 months
A logistic regression (LR) for a binary response on an independent variable with a sample size of 866 participants (90% of whom are in group X = 0 and 10% are in group X = 1) achieves 90% power with 0.05 significance to detect a change in the Probability (Y = 1) of an estimated value of incidence of hypertension of 21.5%
Summary
High blood pressure (HBP) is the leading risk factor for myocardial infarction, cerebrovascular events, atherosclerosis, aortic aneurysms, peripheral arterial disease, heart failure, and chronic kidney disease, among other ailments. Pathophysiological alterations related to microbial dysbiosis, chronic inflammatory states, endothelial dysfunction, increased peripheral vascular resistance, oxidative stress, and immune system responses have been associated to the incidence and prevalence of hypertension [5,6,7,8]. Periodontitis has a high prevalence worldwide, it is known to affect around 30–50% of the population in developed countries [9]. Periodontitis is a chronic inflammatory disease of infectious origins that has drawn increasing attention as a risk factor to develop hypertension and cardiovascular disease (CVD) [10, 11]. The role of the subgingival microbiota in the development of periodontitis, has been clearly identified [12, 13]
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