Abstract
Introduction: Periodontal health is crucial and indispensable element of general health. Epidemiologically, it has been linked with cardiovascular diseases with elevated acute phase reactant C-reactive protein, fibrinogen, and rheological variables such as total leukocyte count and differential leukocyte counts, which are potential predictors of cardiovascular diseases.
Objective: To evaluate and compare cardiovascular disease-related biochemical markers in periodontally healthy subjects, and patients with moderate and severe chronic periodontitis.
Methods: An analytical cross-sectional study was conducted in patients attending Department of Periodontology and Oral Implantology, Chitwan Medical College and Teaching hospital, Bharatpur, Chitwan, Nepal from September 2019 to January 2021. A total of 81 individuals of both gender of which 27 periodontally healthy individuals, 27 diagnosed with moderate and 27 diagnosed with severe periodontitis based on gingival index, probing pocket depth, and clinical attachment level were enrolled in a study. After which, peripheral blood samples were drawn and serum C-reactive protein, plasma fibrinogen, total leukocyte count, and differential leukocyte counts were quantified using the turbidimetric immunoassay. Convenience sampling technique was done. Data was analysed in SPSS v.26.0.
Results: The mean serum levels of C-reactive protein, plasma fibrinogen, total leukocyte and differential leukocytes were found to be statistically (P value <0.001) higher in severe and moderate periodontitis subjects compared to periodontally healthy subjects.
Conclusion: The increased levels of serum C-reactive protein, plasma fibrinogen, total leukocyte count, and differential leukocyte counts in chronic periodontitis contribute to the inflammatory burden of the individual potentially striking toward an increasing risk for cardiovascular events.
References
Newman MG, Takei H, Klokkevold PR, Carranza FA, editors. Carranza's Clinical Periodontology - A South Asia Edition. 11th ed. New Delhi, India: Saunders, Elsevier; 2011
Emingil G, Buduneli E, Aliyev A, Akilli A, Atilla G. Association between periodontal disease and acute myocardial infarction. J Periodontol. 2000 Dec 5;71(12):1882-6.
Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J Periodontol. 2000 Oct;71(10):1554-60.
Kinane DF, Lowe GD. How periodontal disease may contribute to cardiovascular disease. Periodontol 2000. 2000 Jul;23:121-6.
Janket SJ, Baird AE, Chuang SK, Jones JA. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 May;95(5):559-69.
Danesh J, Collins R, Peto R. Chronic infections and coronary heart disease: is there a link? Lancet. 1997 Aug 9;350(9075):430-6.
Williams RC, Offenbacher S. Periodontal medicine: The emergence of a new branch of periodontology. Periodontol 2000. 2000 Jun;23:9-12.
Deshpande RG, Khan MB, Genco CA. Invasion of aortic and heart endothelial cells by porphyromonas gingivalis. Infect Immun. 1998 Nov;66(11):5337-43.
Gupta S, Pradhan S, KC S, Shakya S, Giri M. C-reactive protein in periodontitis and its comparison with body mass index and smoking behaviour. J Nepal Med Assoc. 2017;56(206):226-33.
Gani DK, Lakshmi D, Krishnan R, Emmadi P. Evaluation of crp and interleukin-6 in peripheral blood of patients with chronic periodontitis. J Indian Soc Periodontol. 2009 Sep 16;13(2):69-74.
Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol. 1967 Nov-Dec;38(6):Suppl:610-6.
Spasiano A, Matellon C, Orso D, Brussa A, Cafagna M, Marangone A, et al. Functional fibrinogen (FLEV-TEG) versus the Clauss method in an obstetric population: a comparative study. BMC Anaesthesiol. 2019 Jun 1;19(1):90.
Dhawle A, Patil V, Darakh P. Plasma fibrinogen levels in chronic periodontitis subjects: A pilot study. Int J Recent Sci Res. 2017;8(8):19196-8.
DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. Br Med J. 1993 Mar 13;306(6879):688-91.
Al-Zahrani MS, Bissada NF, Borawski EA. Obesity and periodontal disease in young, middle-aged and older adults. J Periodontol. 2003;74:610-15.
Black S, Kushner I, Samols D. CRP. J Biol Chem. 2004 Nov19;279(47):48487-90.
Rai B, Kharb S, Jain R, Anand SC. Periodontitis, crp and peripheral blood; links with cardiovascular disease. Adv Med Dent Sci. 2009;3(3):76-9.
Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on crp in relation to periodontitis. J Clin Periodontol. 2008 April;35(4):277-90.
Chandy S, Joseph K, Sankaranarayanan A, Issac A, Babu G, Wilson B, et al. Evaluation of crp and fibrinogen in patients with chronic and aggressive periodontitis: A clinico-biochemical study. J Clin Diagn Res. 2017 Mar;11(3):ZC41-5.
Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the centers for disease control and prevention and the american heart association. Circul. 2003;107(3):499-511.
Medved L, Weisel JW. Fibrinogen and factor XIII subcommittee of scientific standardization committee of international society on thrombosis and haemostasis. Recommendations for nomenclature on fibrinogen and fibrin. J Thromb Haemost. 2009 Feb;7(2):355-9.
Sahingur SE, Sharma A, Genco RJ, Nardin ED. Association of increased levels of fibrinogen and -455G/A fibrinogen gene polymorphism with chronic periodontitis. J Periodontol. 2003;74:329-37.
Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, CRP, albumin, or leukocyte count with coronary heart disease: Meta-analyses of prospective studies. J Am Med Assoc. 1998 May;279(18):1477-82.
Hajishengallis, G. New developments in neutrophil biology and periodontitis. Periodontol 2000. 2020 Feb;82(1):78-92.
Kweider M, Lowe GD, Murray GD, Kinane DF, McGowan DA. Dental disease, fibrinogen and white cell count; links with myocardial infarction? Scott Med J. 1993 Jun;38(3):73-4.
Beck JD, Offenbacher S, Williams R, Gibbs P, Garcia R. Periodontitis: A risk factor for coronary heart disease? Ann Periodontol. 1998 Jul;3:127-141.
Kalburgi V, Sravya L, Hazeil DJ. Role of systemic markers in periodontal diseases: A possible inflammatory burden and risk factor for cardiovascular diseases? Ann Med Health Sci Res. 2014 May-June;4(3):388-92.