Periodontitis, Biomarkers and Cardiovascular Disease

描述(由申请人提供)：我们的总体目标是评估慢性牙周病和心血管疾病发病率之间的联系，并前瞻性地评估炎性生物标志物在这种联系中的作用。我们在男性中的流行病学研究结果表明，牙周病与(A)外周动脉疾病(PAD)和(B)缺血性中风风险增加之间存在关联。这项拟议的研究将在两个正在进行的前瞻性研究的男性和女性参与者中进行：健康专业人员的后续研究，有超过50,000名男性，以及护士的健康研究，有超过100,000名女性。我们在相同人群中的前瞻性研究和其他几项研究已经得到支持，以评估牙周病、炎症标志物和冠心病之间的关系。因此，我们将这一应用局限于评估牙周骨丢失与缺血性卒中和PAD之间的关系。在这些队列中，我们已经证明了牙周病与促炎细胞因子、炎症标志物和内皮功能障碍之间的关系。我们将前瞻性地评估牙周病的标准指标与PAD和缺血性卒中的发生率之间的关系，并评估炎症和内皮功能障碍的标志物是否可能介导牙周病和缺血性卒中和PAD之间的联系。这将是第一次评估女性牙周病和PAD之间的关系的研究，也是第一次前瞻性评估牙周病和心血管疾病之间的炎症介质的研究之一。我们将包括所有事故病例和每个病例的两个配对对照，这些病例来自已经提供血液样本的小组，并在征得参与者的同意后从其牙医那里获得他们先前存在的X光照片。生化标记物分析将从我们获得牙科X光照片的参与者的血液样本中进行。缺血性中风和PAD将从医疗记录中得到核实。我们预计每个病例有500个符合条件的缺血性卒中病例、500个PAD病例和2个匹配的对照，总样本量为3,000。由于牙周病非常常见，如果发现它会增加患心血管疾病的风险，数百万人可能会受到影响。这项研究的结果可能表明预防心血管疾病的可能性需要进一步探索。

DESCRIPTION (provided by applicant): Our overall objective is to evaluate the association between chronic periodontal disease and incidence of cardiovascular disease, and to prospectively assess the role of inflammatory biomarkers in this association. Results from our epidemiologic studies among men show associations between periodontal disease and increased risk of (a) peripheral arterial disease (PAD) and (b) ischemic stroke. The proposed study will be conducted among male and female participants of two ongoing prospective studies: the Health Professionals' Follow-up Study, with over 50,000 men, and the Nurses' Health Study with over 100,000 women. Our prospective study in the same populations and several other studies are already supported to evaluate the association between periodontal disease, inflammatory markers and coronary heart disease. Hence we limit this application to evaluating the association between periodontal bone loss and ischemic stroke and PAD. We have demonstrated associations between periodontal disease and pro-inflammatory cytokines, markers of inflammation, and endothelial dysfunction in these cohorts. We will evaluate prospectively the relationship between standard measures of periodontal disease and incidence of PAD and ischemic stroke, and evaluate whether markers of inflammation and endothelial dysfunction may mediate the association between periodontal disease and ischemic stroke and PAD. This will be the first study to evaluate the relationship between periodontal disease and PAD among women, and among the first studies to prospectively evaluate inflammatory mediators in the pathway between periodontal disease and cardiovascular disease. We will include all incident cases and two matched controls per case, from the subgroup who already provided blood samples, and obtain their pre-existing radiographs from their dentists after requesting these participant's consent. The biochemical marker analyses will be conducted from the blood samples participants for whom we obtain dental radiographs. Ischemic stroke and PAD will be verified from medical records. We anticipate 500 eligible cases of ischemic stroke and 500 PAD cases and 2 matched controls per case, with a total sample size of 3,000. Since periodontal disease is very common, if it is found to increase the risk of CVD, millions of people may be impacted. The results from this study may suggest possibilities for prevention of CVD that would need to be further explored.