Dr. Steven Offenbacher and colleagues reported the results of the Periodontitis and Vascular Events (PAVE) study, which was conducted on 303 patients (151 receiving a therapeutic protocol and 152 receiving community care) across 5 coordinated cardiac-dental centers.
The study was designed to measure the effectiveness of an intervention which was part of a secondary cardiac event prevention model. Measurements of effectiveness included levels of high sensitivity C-reactive protein (hs-CRP) and periodontal status as measured by probing. The study did not measure any significant difference between the two treatment groups with relation to bleeding on probing, subgingival calculus, and attachment levels; however, at the 6-month time period there was a significant difference in mean probing depth and the number of 4- or 5-mm pockets. Intent-to-treat data analysis did not reveal a difference in hs-CRP levels at 6 month follow up; however, a separate analysis which looked at patients who had received any type of preventive periodontal care vs those who had no preventive care did show a significant difference in hs-CRP levels (adjusted odds ratio for hs-CRP >3 mg/l at 6 months in patients who were not obese was 0.26 [95% CI: 0.09 to 0.72]). When considering obesity into the analysis, there was no statistical difference. The authors stressed the importance in studies of this nature for considering obesity and preventive periodontal care on interventions for reducing cardiovascular risk. For additional information on the results of this study, please review the following citation: Offenbacher S, Back JD, Kevin M, et al. Results From the Periodontitis and Vascular Events (PAVE) Study: A Pilot Multicentered, Randomized, Controlled Trial to Study Effects of Periodontal Therapy in a Secondary Prevention Model of Cardiovascular Disease. J Periodontol. 2009;80:190-201
A separate study designed to examine the relationship between periodontitis and cardiovascular disease mortality in patients with end-stage renal disease in 168 adults (100 with no disease or mild periodontitis; 68 with moderate to severe periodontitis), found patients in the group with moderate to severe disease had a higher mortality rate of cardiovascular etiology.
The study authors adjusted the analysis for age, gender, smoking status, presence or absence of high blood pressure or diabetes, and the significant and strong association between disease severity and mortality remained high. This study demonstrates the need for larger, well-designed studies to examine these risk factors, as well as the importance of providing periodontal care interventions to determine the effectiveness on the reduction of cardiovascular disease mortality in patients on hemodialysis. For additional information on this study, please review the following article: Kshirsagar AV, Craig RG, Moss KL, et al. Periodontal disease adversely affects the survival of patients with end-stage renal disease. Kidney Int. 2009:Epub ahead of print.
Another study reported on by Franek et al. assessed whether or not chronic periodontitis in patients with essential hypertension was associated with elevation in central blood pressure and/or stiffness of the aorta, resulting in left ventricular mass increase.
A total of 99 patients were evaluated with either severe periodontitis (n=50) or ranging from no to moderate periodontitis (n=49). Linear regression analysis demonstrated an association between left ventricular mass index and severity of periodontitis with borderline significance (P = 0.06). The authors concluded that patients with primary hypertension and severe periodontitis are more likely to experience increased central blood pressure and left ventricular mass. For additional details on the results of this study, please reference the following article: Franek E, Klamczynska E, Ganowicz E, et al. Association of chronic periodontitis with left ventricular mass and central blood pressure in treated patients with essential hypertension. Am J Hypertens. 2009;22:203-7.
February 2009