October 03, 2006
Periodontal Disease Link To Heart Disease

Some scientists theorize that gum disease contributes to the development of atherosclerosis and heart disease. Here's another piece of evidence for the argument that you really ought to floss more often.

CHICAGO -- Researchers found an increased risk of coronary heart disease for people below the age of 60 who have more than four millimeters of alveolar bone loss (the bone that holds the teeth in the mouth) from periodontal disease, according to a new study that is printed in the Journal of Periodontology.

It was found that participants with coronary heart disease had an increase of periodontal disease indicators, including alveolar bone loss, clinical attachment loss and bleeding compared to the group without coronary heart disease.

"This study is distinctive because to our knowledge, it is the first to include both the alveolar bone loss and full mouth recording of clinical attachment loss as measurements of periodontal disease," explains Dr. Karen Geismar, Department of Periodontology, School of Dentistry, Faculty of Health Science, University of Copenhagen, Denmark. "Alveolar bone loss was recently found to be the periodontal variable that had the strongest association to coronary heart disease."

The association between periodontal disease and coronary heart disease has been that chronic infections and the inflammatory response from diseases such as periodontal disease may be involved in the initiation and progression of atherosclerosis.

I'm partial to toothpicks. Flossing is too distracting.

How much do chronic infections contribute to cardiovascular disease? The answer may vary by genetic make-up. A research group has a grant to try to find genetic factors which interact with infections to influence cardiovascular disease risk.

Dr. Harald Göring, principal investigator of the new $1.9 million grant from the National Heart, Lung and Blood Institute, titled “Genetics of Infection and Its Relation to CVD Risk,” says there has not been extensive research on the role infections play in the risk for cardiovascular disease. However, a number of epidemiological studies have shown a higher-than-average prevalence of infections among people who have suffered heart attacks, strokes, and a variety of other ailments.

Some common pathogens might contribute to heart disease risk. But some people might carry genetic variations that make them immune to these common pathogens.

These pathogens include Chlamydia pneumonia, a common cause of pneumonia; Helicobacter pylori, a major cause of ulcers; Porphyromonas gingivalis, commonly associated with gum disease; hepatitis A virus, most commonly spread among school-age children and young adults; herpes simplex virus 1, the cause of cold sores; Cytomegalovirus, or human herpesvirus 5, which particularly affects the salivary glands; and human herpesvirus 8, which induces Kaposi sarcoma in persons with immunodeficiency.

“What we want to know is, since these pathogens are so common and so easily spread, how have some people managed to avoid infection?” asked Göring. “Everyone has been exposed to them, but some people don’t have antibodies for them in their bloodstream, indicating that they’ve never been infected with these pathogens and mounted an immune response. So they may have some innate resistance to infection, some other way of preventing infection in the first place. That could be due to a difference in their genetic makeup.”

In a pilot study with 600 individuals from the San Antonio Family Heart Study, Göring has already shown evidence that there are genetic variants on chromosome 21 that influence susceptibility to Chlamydia pneumonia. Now he wants to look for genetic influences on susceptibility to all seven pathogens in a larger study population.

If pathogens contribute to the development of atherosclerosis and heart disease then we can develop counters such as vaccines, antibiotics, and even gene therapies to enhance immune systems. Plus, we can brush our teeth more often.

Update: While the influence of various pathogens on cardiovascular disease risk remains to be proven the claim that fruits and vegetables lower heart disease risk is based on a much larger body of evidence.

The analysis, published in the current issue of the Journal of Nutrition (Vol. 136, pp. 2588-2593), found that the risk of coronary heart disease (CHD), conditions that cause of 20 per cent of deaths in the US and 17 per cent of deaths in Europe, was cut by four per cent for each additional fruit and vegetable portion consumed, and by seven per cent for fruit portion intake.

The link between the risk of CHD and vegetable intake however was mixed with a more beneficial relationship observed for general cardiovascular mortality (26 per cent risk reduction) than for the more specific fatal and nonfatal heart attacks (myocardial infarction) (five per cent).

I wonder why the bigger benefit from fruits. Anthocyanins?

Share |      Randall Parker, 2006 October 03 09:09 PM  Aging Studies


Comments
Lou Pagnucco said at October 4, 2006 8:31 AM:

Periodontal and cardiovascular diseases are accompanied by elevated markers of systemic inflammation, especially C-Reactive Protein(CRP).

A few ways of significantly reducing CRP (and, hopefully inflammation) are:

- Low-dose doxycycline - see http://www.natural-hrt.com/artman/publish/article_133.shtml

- Caloric resriction - see http://biomed.gerontologyjournals.org/cgi/content/abstract/61/3/211

- Low glycemic-index diets - see http://www.ajcn.org/cgi/content/abstract/75/3/492

- Statins - see http://content.nejm.org/cgi/content/short/352/1/20

- Vitamin C, a 24% reduction is reported at http://www.jacn.org/cgi/content/abstract/23/2/141

- Correcting common magnesium deficiency - see http://www.jacn.org/cgi/content/abstract/24/3/166

- Switching to a Mediterranean diet
- see http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15383514&dopt=Abstract

- Mixed tocopherol, flavonoids, DHA-omega-3 supplementation - see http://grove.ufl.edu/~cleeuwen/Tracey.pdf

- PPAR-gamma agonists
- see http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=14642684

- Many anti-inflammatory drugs and herbs, etc...

Interestingly, many anthocyanins may inhibit the same extra-cellular matrix degrading proteolytic enzymes (collagenases, gellatinases, ...) that are activated in periodontal disease (and are also suppressed by doxycycline).
Refer to: http://www.mirtoselect.com/public/anthocyanins_properties.asp
and http://jn.nutrition.org/cgi/reprint/135/9/2096.pdf

Randall Parker said at October 4, 2006 5:09 PM:

Lou,

Great links.

I like the magnesium link in particular. I've come across reports in the past of magnesium deficiency contributing to the development of type 2 diabetes.

Flavonoids and anthocyanins: I am really surprised that fruits help more than vegetables. It is my (perhaps erroneous) impression that people are eating more of the fruits that have less of flavonoids and other beneficial compounds. The fruits that have the highest concentrations of antioxidants are the berries and cherries. Blueberries, black berries, bing cherries, and assorted other berry and cherry types score highest in the ORAC (Oxygen Radical Absorbance Capacity or something close to that) assay for antioxidant activity for example.

People who want to sweeten their food ought to shift toward use of fruits to do it.

PPAR-gamma agonist rosiglitazone, type II diabetes, and coronary heart disease: Note the study you link to reported higher LDL cholesterol and higher triglycerides from PPAR gamma agonist taking rosiglitazone. However, it also reduced CRP (C Reactive Protein). Not sure what to make of that.

Would taking rosiglitazone reduce one's risk of Alzheimer's? Would rosiglitazone reduce general age-related cognitive decline by increasing glucose supply to aging brain cells?

Glycemic index: I've been eating Basmati rice for its lower glycemic index. But as soon as I finish off the Basmati that I have I'm switching to Uncle Ben's converted rice because it is even lower in glycemic index.

Lou Pagnucco said at October 4, 2006 10:16 PM:

Randall,

Rosiglitazone already has shown some promise in early Alzheimers and clinical trials are starting.

Note that statins seem to reduce cardiac risk even when they lower CRP but not LDL.

Also, if I remember correctly, centenerians have relatively high LDL levels, but also large LDL particle size.

Lastly, the glycemic index of a meal is reduced by including fat and protein - or taking a little vinegar or acetic acid before the meal.

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