Wednesday, April 18, 2012

Study: No Independent Association of Periodontal and Atherosclerotic Vascular Disease?

Patient with periodontal (gum) disease

Yes, no causative relationship according to the latest American Heart Association Scientific Statement:

A link between oral health and cardiovascular disease has been proposed for more than a century. Recently, concern about possible links between periodontal disease (PD) and atherosclerotic vascular disease (ASVD) has intensified and is driving an active field of investigation into possible association and causality. The 2 disorders share several common risk factors, including cigarette smoking, age, and diabetes mellitus. Patients and providers are increasingly presented with claims that PD treatment strategies offer ASVD protection; these claims are often endorsed by professional and industrial stakeholders. The focus of this review is to assess whether available data support an independent association between ASVD and PD and whether PD treatment might modify ASVD risks or outcomes. It also presents mechanistic details of both PD and ASVD relevant to this topic. The correlation of PD with ASVD outcomes and surrogate markers is discussed, as well as the correlation of response to PD therapy with ASVD event rates. Methodological issues that complicate studies of this association are outlined, with an emphasis on the terms and metrics that would be applicable in future studies. Observational studies to date support an association between PD and ASVD independent of known confounders. They do not, however, support a causative relationship. Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD or modify its outcomes.

There is more here.

The AHA committee members conducted a literature search from May 2008 to July 2011 in Ovid MEDLINE on the association between PD and any cerebrovascular, peripheral vascular, or cardiovascular disease. The search covered the period of 1950 to July 2011 and included clinical studies, systematic reviews, and animal studies. A total of 537 peer-reviewed publications met the inclusion criteria.

After analyzing and comparing the findings of these studies, the committee concluded that observational studies to date support an association between PD and ASVD independent of known confounders. Because this information comes mostly from observational studies, however, "it does not demonstrate that PD is a cause of ASVD, nor does it confirm that therapeutic periodontal interventions prevent heart disease or stroke or modify the clinical course of ASVD," they wrote.

In addition, while the data indicate a general trend toward a periodontal treatment-induced suppression of systemic inflammation and improvement of noninvasive markers of ASVD and endothelial function, "the effects of PD therapy on specific inflammatory markers are not consistent across studies," the authors wrote.

The scientific evidence does not establish that gum disease causes or increases rates for heart disease or stroke, according to the American Heart Association in a new scientific statement published April 18 online in its journal, Circulation.

The statement is based on the review of more than 500 journal articles and studies, which did not confirm a causative link between periodontal disease and atherosclerotic vascular disease.

The ADA Council on Scientific Affairs agrees with the AHA’s conclusions in the statement, which were drawn by a committee of experts, including dentists, cardiologists and infectious diseases specialists.

“There’s a lot of confusion out there,” said Dr. Peter Lockhart, CSA representative to the AHA committee and co-chair of the writing group that authored the statement. Dr. Lockhart is a professor and chair of oral medicine at the Carolinas Medical Center in Charlotte, N.C.

 “The message sent out by some in health care professions that heart attack and stroke are directly linked to gum disease can distort the facts, alarm patients and perhaps shift the focus on prevention away from well-known risk factors for these diseases.”

The writing group, also co-chaired by Ann F. Bolger, M.D., concluded that heart disease and periodontal disease often coincidentally occur in the same person due to risk factors of smoking, age and diabetes mellitus common to both diseases.

Doctors have suspected a causative link between heart disease and gum disease for more than a century. But statements implying a cause and effect relationship between the diseases are “unwarranted,” the statement’s authors said.

OK, so no causative link and both diseases share risk factors.

But, in the real world, are patients going to let their periodontal health suffer because their is no provable causal link to cardiovascular disease?

No - better to be safe than sorry.

Keep brushing and flossing folks.

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