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Periodontal infections and cardiovascular disease--how strong is the association?
1Division of Periodontology, Department of Stomatology, University of California, 521 Parnassus Avenue, C-628, Box 0650, UCSF School of Dentistry, San Francisco, CA 94143-0650, USA. garmit@itsa.ucsf.edu
Insights
Chronic infections, including Chlamydia pneumoniae and periodontal disease, are increasingly linked to cardiovascular disease (CVD) and stroke risk. The total microbial burden from multiple infections may be more significant than a single pathogen.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Inflammation Research
Background:
- Atherosclerosis involves significant inflammation, extending beyond lipid accumulation.
- Renewed interest in the hypothesis that infections increase cardiovascular disease (CVD) and stroke risk.
- Several infectious agents, including Chlamydia pneumoniae and Helicobacter pylori, are implicated in coronary heart disease (CHD).
Purpose of the Study:
- To review and contrast evidence linking Chlamydia pneumoniae and periodontal infections to the development of CHD.
- To explore the role of chronic infections as independent risk factors for CVD.
- To investigate the potential impact of combined microbial burden from multiple chronic infections on CVD pathogenesis.
Main Methods:
- Review of existing scientific literature and evidence.
- Summarization of causative role evidence for Chlamydia pneumoniae in CHD.
- Contrasting evidence for Chlamydia pneumoniae and periodontal infection associations with CHD.
Main Results:
- Circumstantial evidence suggests chronic infections are linked to CHD.
- Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpesviruses are associated with increased CHD risk.
- Periodontal infections are also implicated as contributing factors to CHD development.
Conclusions:
- The cumulative microbial burden from multiple simultaneous chronic infections may be a critical factor in CVD.
- Further research and collaboration between cardiologists and periodontists are needed to understand the role of combined infections in CHD and stroke.
- It is unlikely that a single infection is solely causative; the interplay of multiple infections is likely more significant.
Abstract:
In the past decade there has been renewed interest in the old hypothesis that infections increase the risk of developing cardiovascular disease and stroke. There is now a convincing body of evidence that atherosclerosis has a major inflammatory component and is much more than the simple vascular accumulation of lipids. Infectious agents that have been linked to an increased risk of coronary heart disease (CHD) include Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpesviruses. The concept has emerged that each of these agents is an independent risk factor for CHD and that common chronic infections are important. In addition, periodontal infections have also been implicated as one of several factors contributing to the development of CHD. Evidence supporting a causative role of chronic infections in CHD is largely circumstantial. However, the evidence is sufficiently strong to warrant further examination of the possible link between chronic infections and CHD. In this review the lines of evidence for a causative role of C. pneumoniae in the development of CHD are summarized and contrasted with the lines of evidence suggesting a periodontal infection--CHD association. If common or widespread chronic infections are truly important risk factors for CHD, it is unlikely that a single infection will be shown to be causative. It is likely that the entire microbial burden of the patient from several simultaneous chronic infections is more important (e.g., H. pylori-caused gastric ulcers + C. pneumoniae-caused bronchitis + periodontitis). Increased cooperation between cardiologists and periodontists will be required to determine if, and what, combinations of common chronic infections are important in the pathogenesis of CHD and stroke.