Periodontitis is associated with incidental valvular heart disease: A nationwide population-based cohort study

The link between periodontitis and atherosclerotic cardiovascular disease in non-Hispanic White adults: NHANES 1999 to 2014

BACKGROUND

Limited research exists on the association between periodontitis and Atherosclerotic Cardiovascular Disease (ASCVD) in American adults. Chronic inflammation from periodontitis may elevate ASCVD risk by promoting systemic inflammation and endothelial dysfunction, supporting the plausibility of this relationship. Therefore, we utilized data from the National Health and Nutrition Examination Survey (NHANES) database to investigate this association.

METHODS

We conducted a cross-sectional study using NHANES data from 1999-2004 and 2009-2014, including 5,380 individuals from the United States. Tooth loss and periodontitis were assessed through full-mouth periodontal examinations. The 10-year ASCVD risk was calculated based on the 2013 American College of Cardiology (ACC) and American Heart Association (AHA) recommendations. We employed univariate and multivariable logistic regression models, as well as subgroup and interaction analyses.

RESULTS

Among participants, 74.96% experienced tooth loss, 15.99% had moderate/severe periodontitis, and the average age was 59.64 years. ASCVD was found to be associated with moderate/severe periodontitis (OR 1.24, 95% CI 1.01-1.52, P= 0.0411) and tooth loss (OR 1.16, 95% CI 1.09-1.39, P= 0.0248) in logistic regression models after full adjustment.

CONCLUSION

Our study establishes a significant link between moderate/severe periodontitis and the increased risk of ASCVD over a decade in American adults aged 40-79 years.

Exploring the Interaction Between HLA-B27 and Other Risk Factors of Valvular Heart Disease in Axial Spondyloarthritis

OBJECTIVES

HLA-B27 plays a critical role in axial spondyloarthritis (axSpA). Valvular heart disease (VHD) is a life-threatening extra-articular manifestation of axSpA. The evidence for the association between HLA-B27 and VHD in axSpA is still scarce and controversial. In this study, we aim to mainly explore the association of HLA-B27 and VHD in axSpA, and the interaction between HLA-B27 and other risk factors of VHD in axSpA.

METHODS

We analyze cross-sectional data of axSpA patients from 2016 to 2022 in Shenzhen Second People's Hospital. Multivariable logistic regression models were fitted to evaluate the association between HLA-B27 and VHD in axSpA patients. When discovering the interaction between HLA-B27 and sex and disease duration, we made stratified analyses.

RESULTS

Included were 444 axSpA patients with echocardiography during inpatient admission. Males were 299, and females were 145. In the adjusted model of multivariable logistic analysis, only age increased the risk of VHD (OR 1.054; 95% CI 1.021-1.087). To detect interactions between HLA-B27 and other variables that affected the outcome of VHD, sex and categorical disease duration were found to interact with HLA-B27 after being adjusted by age (p < 0.05). In sex-stratified analysis, male patients with HLA-B27 increased the risk of VHD (OR 11.2; 95% CI 1.40-89.36) after being adjusted by age. In stratified analysis of disease duration, over 24 months of duration increased the risk of VHD (OR 5.86; 95% CI 1.27-27.07).

CONCLUSIONS

Our study provided evidence that age was the only independent risk factor for VHD in axSpA. HLA-B27 interacted with sex and disease duration to increase the risk of VHD in axSpA patients.

Exploring links between oral health and infective endocarditis

Infective endocarditis (IE) is a bacterial infection of the heart's inner lining. A low incidence rate combined with a high mortality rate mean that IE can be difficult to treat effectively. There is currently substantial evidence supporting a link between oral health and IE with the oral microbiome impacting various aspects of IE, including pathogenesis, diagnosis, treatment, and mortality rates. The oral microbiome is highly diverse and plays a crucial role in maintaining oral health by providing protective functions. However, when dysbiosis occurs, conditions such as periodontal or peri-implant disease can arise, offering a pathway for bacteraemia to develop. The role of the oral microbiome as a coloniser, facilitator and driver of IE remains to be uncovered by next-generation sequencing techniques. Understanding the dysbiosis and ecology of the oral microbiome of IE patients will allow improvements into the diagnosis, treatment, and prognosis of the disease. Furthermore, an increased awareness amongst those at high-risk of developing IE may encourage improved oral hygiene methods and lower incidence rates. This narrative review examines current findings on the relationship between oral health and IE. It draws from key studies on both topics, with manuscripts selected for their pertinence to the subject. It highlights the link between the oral microbiome and IE by exploring diagnostic techniques and treatments for IE caused by oral commensals.

Gut Microbiome and Its Role in Valvular Heart Disease: Not a "Gutted" Relationship

The role of the gut microbiome (GM) and oral microbiome (OM) in cardiovascular disease (CVD) has been increasingly being understood in recent years. It is well known that GM is a risk factor for various CVD phenotypes, including hypertension, dyslipidemia, heart failure and atrial fibrillation. However, its role in valvular heart disease (VHD) is less well understood. Research shows that, direct, microbe-mediated and indirect, metabolite-mediated damage as a result of gut dysbiosis and environmental factors results in a subclinical, chronic, systemic inflammatory state, which promotes inflammatory cell infiltration in heart valves and subsequently, via pro-inflammatory molecules, initiates a cascade of reaction, resulting in valve calcification, fibrosis and dysfunction. This relationship between GM and VHD adds a pathophysiological link to the pathogenesis of VHD, which can be aimed therapeutically, in order to prevent or regress any risk for valvular pathologies. Therapeutic interventions include dietary modifications and lifestyle interventions, in order to influence environmental factors that can promote gut dysbiosis. Furthermore, the combination of probiotics and prebiotics, as well as fecal m transplantation and targeted treatment with inducers or inhibitors of microbial enzymes have showed promising results in animal and/or clinical studies, with the potential to reduce the inflammatory state and restore the normal gut flora in patients. This review, thus, is going to discuss the pathophysiological links behind the relationship of GM, CVD and VHD, as well as explore the recent data regarding the effect of GM-altering treatment in CVD, cardiac function and systemic inflammation.

The Oral Microbiota in Valvular Heart Disease: Current Knowledge and Future Directions

Oral microbiota formation begins from birth, and everything from genetic components to the environment, alongside the host's behavior (such as diet, smoking, oral hygiene, and even physical activity), contributes to oral microbiota structure. Even though recent studies have focused on the gut microbiota's role in systemic diseases, the oral microbiome represents the second largest community of microorganisms, making it a new promising therapeutic target. Periodontitis and dental caries are considered the two main consequences of oral bacterial imbalance. Studies have shown that oral dysbiosis effects are not limited locally. Due to technological advancement, research identified oral bacterial species in heart valves. This evidence links oral dysbiosis with the development of valvular heart disease (VHD). This review focuses on describing the mechanism behind prolonged local inflammation and dysbiosis, that can induce bacteriemia by direct or immune-mediated mechanisms and finally VHD. Additionally, we highlight emerging therapies based on controlling oral dysbiosis, periodontal disease, and inflammation with immunological and systemic effects, that exert beneficial effects in VHD management.