Low levels of antibodies for the oral bacterium Tannerella forsythia predict cardiovascular disease mortality in men with myocardial infarction: A prospective cohort study

Lise Lund Håheim,D.S. Thelle,I. Olsen,P.E. Schwarze,K.S. Rønningen,P. Nafstad

doi:10.1016/j.mehy.2020.109575

Abstract

Antibody levels to periodontal pathogens in prediction of cardiovascular disease (CVD) mortality were explored using data from a health survey in Oslo in 2000 (Oslo II-study) with 12 1/2 years follow-up. IgG antibodies to four common periodontal pathogens; Tannerella forsythia (TF), Porphyromonas gingivalis (PG), and Treponema denticola (TD) all termed collectively the “red complex”, and Aggregatibacter actinomycetemcomitans(AA) were analysed. The study sample consisted of 1172 men drawn from a cohort of 6,530 men who participated in the Oslo II-study, where they provided information on medical and dental history. Of the study sample, 548 men had reported prior myocardial infarction (MI) at baseline whereas the remaining 624 men were randomly drawn from the ostensibly healthy participants for comparative analyses. Dental anamnestic information included tooth extractions and oral infections. An inverse relation was found for trend by the quartile risk level of TF predicting CVD mortality, p-value for trend = 0.017. Comparison of the first to fourth quartile of TF antibodies resulted in hazard ratio (HR) = 1.82, 95% confidence interval 1.12–2.94, p = 0.015, adjusted for age, education, diabetes, daily smoking, and systolic blood pressure. Specificity comparing decile 1 to deciles 2–10 of TF predicting mortality was 92.3%. We found an increased HR by low levels of antibodies to the bacterium T. forsythia predicting CVD mortality in a 12 ½ years follow-up in persons who had experienced an MI but not among non-MI men. This novel finding constitutes a plausible causal link between oral infections and CVD mortality.

Highlights

Many bacteria have been identified in advanced “chronic” period ontal disease but three bacteria are commonly identified and are jointly termed the ‘Red complex’ [1,2,3]
The highest maximum IgG values were against Porphyromonas gingivalis (PG) (8,710) for myocardial infarction (MI) and 5,299 for non-MI, and the lowest were those against Treponema denticola (TD) with 2,166 for MI and 1,204 for non-MI
T. forsythia is an initiator of advanced “chronic” periodontal infection, allowing for the progression of periodontitis by the joint effect of the ‘Red complex’ bacteria on cardiovascular struc tures

Summary

Introduction

Many bacteria have been identified in advanced “chronic” period ontal disease but three bacteria are commonly identified and are jointly termed the ‘Red complex’ [1,2,3] The latter comprises the strict anae robic bacteria Tannerella forsythia (TF), Porphyromonas gingivalis (PG), and Treponema denticola (TD). These bacteria act in symbiosis under the progression of the infection through their production of several viru lence factors and they possess the ability to evade host reactions re sulting in soft and hard tissue destruction in the oral cavity [4,5,6,7,8]. Examples are DeStafano et al who found an increased risk of atherosclerotic plaque formation associated with dental disease in 9760 patients over a 14 years followup [11], and in a case-control study Mattila et al showed an association between periodontal disease and heart disease [12]

Results

Discussion

Conclusion