Periodontal disease and atherosclerosis: from dental to arterial plaque.
Periodontal disease and atherosclerosis: from dental to arterial plaque.
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DOI：
10.1161/01.atv.0000087144.24654.71
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发表时间：
2003-08
期刊：
影响因子：
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通讯作者：
W. Haynes;C. Stanford
中科院分区：
文献类型：
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作者：
W. Haynes;C. Stanford
动脉粥样硬化的传统危险因素是很好理解的，但它们只能占一般人群动脉粥样硬化事件的约50%至70%。动脉粥样硬化的许多其他假定的危险因素已被提出，包括与肥胖，炎症和感染有关的特征。牙周病是一个候选的危险因素，共享许多这些相关的特征。牙周病反映了一系列口腔病理学，从牙龈炎（牙龈炎症）到严重的牙周炎（牙龈附着的进行性丧失），伴有牙槽骨和牙齿脱落。牙周病的发病机制被认为是由于牙菌斑（龈下生物膜中的细菌）的积累，从而导致粘膜感染和炎症。异常的宿主反应，伴随基质金属蛋白酶的上调，导致某些患者的疾病进展更快。牙周病在吸烟、肥胖和糖尿病中更为常见，它影响了美国约75%的成年人，其中约20%至30%的成年人患有严重的牙周病。多项横断面研究表明，牙周病患者动脉粥样硬化并发症的发生率更高。3 -6在NHANES III队列中，严重牙周病与心肌梗死的发生率几乎是无牙周病患者的4倍。6在横断面研究中，与牙周病相关的心血管风险似乎取决于疾病的严重程度，它独立于传统的风险因素（包括吸烟、贫困、糖尿病和体重指数）。7横断面和病例对照研究的一个问题是，它们不能告诉我们一种疾病是另一种疾病的原因还是后果。例如，动脉粥样硬化可能会加剧牙周病，通过...
The conventional risk factors for atherosclerosis are well understood, but they can account for only about 50% to 70% of atherosclerotic events in the general population. Many other putative risk factors for atherosclerosis have been proposed, including traits related to obesity, inflammation, and infection. Periodontal disease is a candidate risk factor that shares many of these related traits. The periodontal diseases reflect a spectrum of oral pathology from gingivitis (gum inflammation) to severe periodontitis (progressive loss of gum attachment) with alveolar bone and tooth loss. See page 1405 The pathogenesis of periodontal disease is thought to be due to accumulation of dental plaque (bacteria in subgingival biofilms) with consequent mucosal infection and inflammation. Abnormal host responses, with upregulation of matrix metalloproteinases, contribute to a more rapid disease progression in some patients. Periodontal disease is more common with cigarette smoking, obesity, and diabetes, and it affects about 75% of the adult population in the United States, with about 20% to 30% of adults having severe forms.1,2⇓ Increasing evidence over the past decade suggests a link between periodontal disease and atherosclerosis. Multiple cross-sectional studies have demonstrated a higher incidence of atherosclerotic complications in patients with periodontal disease.3–6⇓⇓⇓ In the NHANES III cohort, severe periodontal disease was associated with an almost 4-fold higher incidence of myocardial infarction than found in patients without periodontal disease.6 In cross-sectional studies, the cardiovascular risk associated with periodontal disease appears dependent on severity of the disease, and it is independent of conventional risk factors (including smoking, poverty, diabetes, and body mass index).7 One problem with cross-sectional and case-control studies is that they do not tell us whether a disease is a cause or a consequence of another condition. For example, it is possible that atherosclerosis might exacerbate periodontal disease, by …