Systemic Exposure to Oral Infections : a Cardiometabolic Risk

Cardiometabolic risk indicates a cluster of factors predisposing to cardiovascular diseases (CVDs) and diabetes mellitus. Chronic infections may contribute to the total cardiometabolic risk e.g. via an increased systemic inflammation. Periodontitis and apical periodontitis (AP) are often asymptomatic and among the world’s most prevalent infectious diseases. If left untreated, the affected teeth might need to be extracted. The general hypothesis of this thesis was that periodontitis and AP increase the risk for CVD due to pro-inflammatory bacterial mediators, such as lipopolysaccharide (LPS). A humoral immune response towards periodontal pathogens might indicate an immunologically hyperresponsive phenotype susceptible for chronic inflammatory diseases or serve as a biomarker for the oral pathogen burden. The antibodies might also have direct proatherogenic effects via molecular mimicry, cross-reaction with the host cells. Our aim was to investigate associations between oral infectious diseases, oral bacteria, along with their respective adaptive immune response, endotoxemia and CVD. We utilized three observational cohorts: Health 2000 survey, the Parogene study and the FINRISK 1997 study. Subjects with a history of periodontitis had an elevated antibody response to the selected bacteria, and subjects with active periodontitis had simultaneously elevated oral pathogen levels. A combination of oral pathogens and corresponding antibodies has biomarker potential in periodontal diagnostics. Especially in periodontitis patients, the subgingival abundance of several periodontal pathogens contributed significantly to salivary LPS levels, which in turn associated with endotoxemia. High serum LPS activity associated with stable coronary artery disease (CAD), showing that LPS is a potential mediator between periodontitis and CAD. An elevated humoral immune response towards periodontal pathogens indicated an increased risk for acute coronary syndrome (ACS), representing another plausible path of mediation. Information on missing teeth added the clinical value of the established cardiometabolic risk profiles and associated with incident CVD, diabetes or death. The number of missing teeth is a practical marker for crude evaluation of cardiometabolic risk and it has potential as a self-report variable in large surveys. AP might increase systemic inflammation via similar mechanisms as periodontitis. In our study, AP associated with CAD, especially ACS. Oral infectious foci should be thoroughly evaluated by routine, as they provoke an increased risk for chronic non-communicable diseases in addition to an impaired oral health. Special focus should be directed towards patients with other cardiometabolic risk factors. We have provided novel information on endotoxemia and immunologic burden to periodontal pathogens as potential mediators between these diseases.

Grantor dc:publisher

Helsingin yliopisto

Year dc:date.issued

2017

Author dc:creator

• Liljestrand, John

Statement dc:rights

• Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.
• This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.
• Publikationen är skyddad av upphovsrätten. Den får läsas och skrivas ut för personligt bruk. Användning i kommersiellt syfte är förbjuden.

Language dc:language.iso

eng

Handle dc:identifier.uri

http://hdl.handle.net/10138/227958

OAI record oai:identifier

https://helda.helsinki.fi/server/oai/request?verb=GetRecord&metadataPrefix=dim&identifier=oai%3Ahelda.helsinki.fi%3A10138%2F227958