Severe periodontal disease is associated with a high-risk phenotype of coronary plaques and a higher severity of coronary atherosclerosis, as assessed by Coronary Computed Tomography Angiography

Abstract

Abstract Introduction Although incompletely understood, the relationship between coronary heart disease (CHD) and periodontal disease (PD) is well known. A variety of indices can be used to identify periodontal disease. The lack of strict criteria in defining PD represents a challenge in studying the link with CHD. Data from the literature regarding the relationship between different periodontal indices and CHD are extremely limited. Purpose To investigate the link between the PD indices, coronary calcifications and plaque features in patients with CHD who underwent coronary computed tomography angiography (CCTA). Methods The study included 52 patients with PD in whom (CCTA) revealed CHD. All patients underwent a complex oral examination of the periodontal status and the following indices were assessed: gingival index (GI), plaque index (PqI), calculus index (CI), furcation defects (FI), papillary bleeding index (PBI), tooth mobility, clinical attachment loss (CAL) and probing pocket depth (PPD). The indices were determined for the tooth’s 1.6, 2.1, 2.4, 3.6, 4.1, 4.4 and the final score for each index was obtained by summing the values from the six teeth. The association between the periodontal indices and CCTA features (total coronary artery calcium and vulnerability markers) was evaluated using Graph Pad InStat 3.10 software. The p value was set at 0.05 for statistical significance. Results The mean age of the study population was 54.48 ± 12.83 years old with a male to female ratio of 2.46. At the CCTA examination, mean total coronary artery calcium score was 284.20 ± 418.00. An association between the total coronary artery calcium score and GI (r2=0.12, p=0.01), PqI (r2=0.07, p=0.04), CI (r2=0.10, p=0.01), PBI (r2=0.12, p=0.01), PPD (r2=0.08, p=0.03) was found. Assessment of CCTA features of vulnerability at the level of atherosclerotic plaques indicated a strong association between periodontal indexes and plaque vulnerability: p<0.01 for association between CAL and spotty calcification, positive remodeling and napkin ring sign, p=0.009 for association between PPD and spotty calcification, and p=0.01 for association between tooth mobility and positive remodeling. Conclusions In patients with concomitant PD and CHD, the severity of periodontal disease seems to be associated with severity of atherosclerotic disease, assessed by the total coronary artery calcium score. At the same time, severity of PD is associated with a more expressed vulnerability of coronary plaques, indicating a high-risk phenotype of atheromatous plaques in patients with concomitant PD, and systemic inflammation is most likely the link between the two conditions.