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Improving Endothelial Function via . . . the Gums?

Intensive treatment of severe periodontitis improved endothelial function in a randomized, controlled trial that did not track long-term outcomes.

Some research has suggested an association between periodontitis and cardiovascular disease, possibly mediated by systemic inflammation. In a new study of endothelial function and biomarkers of inflammation, researchers randomized patients with severe periodontitis to receive intensive treatment for that condition or standard, community-based periodontal care. Of 1079 patients initially screened, 120 eligible patients (mean age, 48; 50% men) were randomized; 114 completed the study.

Periodontal outcomes were significantly better with intensive treatment than with standard care at both 2 months and 6 months. At 24 hours, the intensively treated group exhibited worse endothelial function (assessed by flow-mediated dilatation) and worse nitroglycerin-mediated dilatation (which is endothelium-independent) than did the control group. At 2 months and at 6 months, nitroglycerin-mediated dilatation was similar in the two groups, and endothelial function was significantly better in intensively treated patients than in controls. No adverse cardiovascular events were documented.

Levels of inflammatory biomarkers (plasminogen-activator inhibitor type 1, C-reactive protein, interleukin-6, von Willebrand factor, soluble E-selectin, and neutrophil count) were higher in the intensively treated group than in the control group at 24 hours. By 2 and 6 months, levels of most biomarkers were similar in two groups, and the intensively treated group had significantly lower E-selectin and neutrophil levels.

Comment: Severe periodontitis merits treatment for reasons other than possible vascular protection. Still, this study provides further evidence of that possibility. Establishing a definitive link will require a long-term randomized trial that tracks cardiovascular outcomes, not just risk markers.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology February 28, 2007

Citation(s):

Tonetti MS et al. Treatment of periodontitis and endothelial function. N Engl J Med 2007 Mar 1; 356:911-20.

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