|Year : 2014 | Volume
| Issue : 4 | Page : 249-253
Association between chronic periodontal disease and cardiovascular risk factor hyperlipidemia
Anitha Akkaloori1, Parthasarathi Parthasarathi2, Mohammad Shakeel Anjum2, Praveen Gadde3, Monica Mocherla3, Yadav Rao2
1 Department of Public Health Dentistry, Mamata Dental College, Khammam, India
2 Sri Sai College of Dental Surgery, Vikarabad, India
3 Department of Public Health Dentistry, Vishnu Dental College, Bhimavaram, Andhra Pradesh, India
|Date of Web Publication||10-Dec-2014|
Department of Public Health Dentistry, Mamata Dental College, Khammam - 507001, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
Background: Periodontal disease is one of the major reasons for tooth loss. Accumulating evidence suggests that chronic infections, such as periodontitis, are associated with increased risk for cardiovascular diseases (CVD) possibly through providing a systemic inflammation and found that 25% to 50% increase in risk of CVD for those with periodontitis when compared to those with no or minimal periodontitis.
Aim: To evaluate the association between chronic periodontal disease and cardiovascular risk factor such as hyperlipidemia.
Materials and Methods: A hospital-based study was conducted among the patients who came to the out-patient department. Fifty subjects including both males and females were selected by systematic random method, and community periodontal index was recorded on all subjects. Subjects were divided in to healthy group (controls) and chronic periodontitis group (cases) based on presence/ absence of loss of attachment. Blood samples were collected from all subjects for the measurement of lipid profile in the serum.
Results: Mean total cholesterol values in controls and cases were 190.44 and 200.64, which were not statistically significant between the groups. Mean LDL cholesterol values in controls and cases were 110.96 and 136.64, which were statistically increased in cases (P = 0.003). Mean HDL cholesterol values in controls and cases were 61.60 and 49.28, which were statistically higher in controls (P = 0.041).
Conclusion: Chronic periodontitis patients may have high risk of getting cardiovascular diseases since cardiovascular risk factors such as total cholesterol and LDL are associated with periodontitis.
Keywords: Chronic periodontitis, cardiovascular diseases, and cholesterol levels
|How to cite this article:|
Akkaloori A, Parthasarathi P, Anjum MS, Gadde P, Mocherla M, Rao Y. Association between chronic periodontal disease and cardiovascular risk factor hyperlipidemia. J NTR Univ Health Sci 2014;3:249-53
|How to cite this URL:|
Akkaloori A, Parthasarathi P, Anjum MS, Gadde P, Mocherla M, Rao Y. Association between chronic periodontal disease and cardiovascular risk factor hyperlipidemia. J NTR Univ Health Sci [serial online] 2014 [cited 2020 Apr 2];3:249-53. Available from: http://www.jdrntruhs.org/text.asp?2014/3/4/249/146628
| Introduction|| |
Periodontitis is a chronic inflammatory disease, which destroys connective tissue and bone that support the teeth. Periodontal disease is one of the major reasons for tooth loss and impaired oral health. Poor oral health may have a profound effect on general health, and the experience of pain, problems with eating, chewing, smiling, and communication due to missing teeth have a major impact on people's daily lives and well-being. Severe periodontitis, which may result in tooth loss, is found in 5-20% of most adult population worldwide. 
India is experiencing a rapid health transition, with large and rising burden of chronic diseases, and the Global Burden of Disease Study, estimated that the number of deaths attributable to chronic diseases would rise from 3·78 million in 1990 (40·4% of all deaths) to 7·63 million in 2020 (66·7% of all deaths). 
Among all the chronic diseases, cardiovascular diseases are the most prevalent diseases, which are responsible for high morbidity and mortality among young adults. Compared with all other countries, India suffers the highest loss in potentially productive years of life, due to deaths from cardiovascular disease in people aged 35-64 years (9·2 million years lost in 2000). By 2030, this loss is expected to rise to 17·9 million years-940% greater than the corresponding loss in the USA, which has a population a third the size of India's population. 
Accumulating evidence suggests that chronic infections, such as periodontitis, are associated with increased risk for cardiovascular diseases (CVD) possibly through providing a systemic inflammation and found that 25% to 50% increase in risk of CVD for those with periodontitis when compared to those with no or minimal periodontitis. 
Recent studies have shown that there is an association between the dyslipidemia, chronic periodontitis, and atherosclerosis, which can lead to mortality and morbidity because of cardiovascular diseases. ,
Hyperlipidemia is a state of abnormal lipid profile, which is characterized by elevated blood concentrations of triglycerides (TG), elevated levels of total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL), and decreased levels of high-density lipoprotein-cholesterol (HDL).
Higher incidence of poor oral hygiene and periodontal disease are associated with increased risk of cerebrovascular, coronary, and peripheral vascular atherosclerotic diseases. 
And, most of the risk factors for cardiovascular diseases are also regarded as risk factors for periodontal diseases. 
Studies have been conducted to know the association between chronic periodontitis and cardiovascular diseases, ,, but the mechanism of the association is not yet clearly understood.
Chronic periodontitis is also associated with increased levels of cholesterol levels in blood. Very few studies  have been conducted to know the association between hypercholesterolemia, cardiovascular disease, and periodontal disease, but the exact mechanism behind the association is not clear.
Hence, the aim of the present study is to evaluate the association between chronic periodontal disease and cardiovascular risk factors like hyperlipidemia in blood.
| Materials and Methods|| |
A cross-sectional survey was conducted on a sample of patients who came to the out-patient department of Sri Sai College of Dental Surgery, Vikarabad, Andhra Pradesh over a period of 6 months from March to August 2011. The age group of the study subjects ranged from 30 to 60 years old. Ethical clearance was obtained from the Ethical Committee of Sri Sai College of Dental Surgery, Vikarabad. Participants were explained about the study, and written consent was taken from every subject who participated in the study.
Pilot study was conducted on 6 cases and 6 controls (convenience sample) to know the feasibility of the study and for sample size calculation, and total sample size was determined as 25 in each group. Systemically healthy subjects were selected by systematic random sampling technique (every 3rd person).
Systemically healthy subjects
Chronic smokers, chronic alcoholics, BMI > 25 kg/m 2
After the selection of subjects based on inclusion and exclusion criteria, periodontal examination was done to all subjects. Community periodontal index was recorded for all subjects. According to community periodontal index, those subjects who are having loss of attachment of less than 4 mm in all sextants were considered as healthy group (Controls). Those subjects who are having loss of attachment of more than 4 mm for at least one sextant were considered as chronic periodontitis group (Cases). Both the groups were matched for age and sex, and all the subjects were referred to clinical pathology laboratory for collection of blood samples and for the analysis of lipid profile in serum. ECG was taken to all subjects to know whether they have any abnormalities in ECG, and body mass index (BMI) of each subject was also measured. Subjects who had BMI more than 25 kg/m 2 were excluded from the study.
The collected data was entered in to Microsoft excel 2007 and subjected to statistical analysis using SPSS version 16.0. The quantitative data was summarized using means and standard deviations. Multivariate analysis was done to compare the dependent variable with independent variables. The statistical tests used were t-test and multivariate analysis. In the present study, level of significance was considered as < 0.05.
| Results|| |
A total number of 50 subjects with the age range between 30 and 60 years participated in the study.
The mean age of the subjects in control was 39.88 + 8.16 years and cases were 42.92 + 10.11 years ([Table 1] and [Table 2] show the distribution of study subjects according to age and gender respectively).
Difference between age groups was not statistically significant (P = 0.124).
[Table 3] shows the comparison of different cholesterol levels between the groups. [Table 4] shows the multivariate comparison between the dependent variable (presence/absence of periodontitis) and independent variables.
|Table 4: Multivariate Comparison Between The Dependent Variable (Presence / Absence Of Periodontitis) And Independent Variables|
Click here to view
| Discussion|| |
A cross-sectional study was conducted to evaluate the association between chronic periodontal disease and cardiovascular risk factor such as hyperlipidemia.
In the present study, total cholesterol, high density lipoprotein, low density lipoprotein, very low density lipoprotein, and triglycerides in serum were measured for subjects with chronic periodontitis and without chronic periodontitis.
Cardiovascular diseases are the leading cause of adult mortality and morbidity throughout the world. The development of cardiovascular diseases can result from genetic and several environmental risk factors such as age, abnormal serum lipids, diabetes, smoking, and hypertension. ,
These well-known risk factors independently or combined are involved in atherosclerosis, which is responsible for cardiovascular diseases. , Not only these risk factors, viral and bacterial infections may also contribute to acute thromboembolic events in susceptible persons. 
Periodontal diseases are a group of inflammatory diseases, in which bacteria and their byproducts are the principal etiologic agents.  There is growing evidence that poor dental health, especially the presence of periodontal disease, increases the risk of cardiovascular diseases. ,
In this study, there was an increased levels of total cholesterol in chronic periodontitis patients, but there was no statistical significant difference between chronic periodontitis subjects and healthy subjects related to total cholesterol levels (P = 0.173), and this finding was similar to a study conducted by Saxlin T et al.  in 2008 and Aiuto et al.,  in 2005, in which they have compared the cholesterol levels in chronic periodontitis patients and healthy group; the results showed that there was an increase in total cholesterol levels in cases. This finding in the present study might be due to chronic localized inflammation may cause systemic inflammation, which results in increased cholesterol level in chronic periodontitis patients.
In the present study, HDL cholesterol levels were significantly higher (P = 0.041) in healthy subjects when compared to chronic periodontitis subjects; this finding in the present study was comparable to a study conducted by Buhlin et al.  in 2003, in which HDL cholesterol levels were lower in subjects with chronic periodontitis. This finding in the present study was in contrast to a study done by Tiejian Wu et al.  in 2000, in which the authors analyzed the relationship between blood serum lipids, CRP levels, and periodontal condition, and the study findings showed that there was no difference in the blood serum concentration of HDL cholesterol between the people with healthy periodontium and those with chronic periodontitis.
In the present study, there was a significant increase in LDL cholesterol levels (P = 0.003) in chronic periodontitis subjects when compared to healthy subjects, which was in agreement with a study done by Losche et al.  in 2005. This finding in the present study might be due to the fact that the chronic periodontitis subjects may have systemic inflammation through periodontitis, which results in increased LDL cholesterol in the serum.
This finding in the present study was in contrast to a study conducted by P. J. Pussinen  in 2004, in which authors evaluated whether periodontal treatment affects proatherogenic properties of low-density lipoprotein (LDL) and, thus, macrophage activation, and that study results showed that the number of sites with bleeding on probing correlated negatively with LDL cholesterol (r = −0.497).
There was a significant increase in VLDL cholesterol levels (P = 0.05) in chronic periodontitis subjects when compared to healthy subjects, and this finding in the present study was similar to a study done by Rao et al.,  in 2011. The present study finding might be due to the fact that chronic inflammations like periodontitis affects the VLDL levels in serum.
There was no significant difference between chronic periodontitis subjects and healthy subjects related to triglycerides (P = 0.156), and this finding in this study was comparable to a study conducted by Giedre et al.  in 2005, in which the authors analyzed the relationship between blood serum lipids and periodontal condition, as well as the relationship between the left ventricular mass index and the condition of periodontium, and the study findings showed that there was no difference in the blood serum concentration of triglycerides between people with healthy periodontium and those with gingivitis or periodontitis.
The present study demonstrated a significant association between hypercholesterolemia and chronic periodontal disease and a possible association between cardiovascular diseases and chronic periodontal disease. The present study was a cross-sectional investigation and did not allow to interpret the results in a causal context. Chronic periodontitis might be a risk indicator for cardiovascular diseases.
In the present study, history regarding physical activity and diet history of protein intake, coffee consumption were not taken, which could alter the different cholesterol levels. However, in the present investigation, obese subjects were excluded from the study, and BMI of the subjects were recorded to eliminate the bias because of physical activity and diet.
However, while the evidence continues to accumulate, it still does not establish periodontal disease as a proven risk factor for CVD. Additional interventional and follow up studies will be required with larger sample to further define this relationship.
| Conclusion|| |
In the present study, there was an association between chronic periodontitis and cardiovascular risk factors like hyperlipidemia. LDL-cholesterol was significantly increased in subjects with chronic periodontitis than in healthy subjects, which is risk factor for cardiovascular diseases. HDL-cholesterol levels were significantly increased in healthy subjects than in subjects with chronic periodontitis. Total cholesterol levels were increased in chronic periodontitis patients than in healthy subjects, but there was no significant difference between chronic periodontitis group and healthy group related to total cholesterol levels. Triglycerides and VLDL Cholesterol levels were increased in subjects with chronic periodontitis than in subjects without periodontitis, but there was no significant difference between them. Hence, chronic periodontitis patients may have high risk of getting cardiovascular diseases like atherosclerosis and angina pectoris, which can lead to high morbidity and mortality among periodontitis patients. The present study results suggest a potential effect of periodontitis-driven systemic inflammation on lipid metabolism. It was observed that there is an association between periodontal disease and CVD.
Suggestions and recommendations
- There is a need to conduct the longitudinal studies to know the causal association between periodontitis and cardiovascular diseases.
- Patients with periodontal diseases are advised to monitor the cardiovascular risk factors like lipid profile in the blood to prevent the cardiovascular diseases among them.
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[Table 1], [Table 2], [Table 3], [Table 4]