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Song Q, Zhang H, Su Y, Song J. The link between periodontitis and atherosclerotic cardiovascular disease in non-Hispanic White adults: NHANES 1999 to 2014. PLoS One 2025; 20:e0321220. [PMID: 40299909 PMCID: PMC12040079 DOI: 10.1371/journal.pone.0321220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Accepted: 03/03/2025] [Indexed: 05/01/2025] Open
Abstract
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.
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Affiliation(s)
- Qingna Song
- Department of Intensive Care Unit, The Affilated Hospital of Qingdao University, Qingdao, China
| | - Hongyan Zhang
- Department of Nursing Department, The Affilated Hospital of QingDao University, Qingdao, China
| | - Yuan Su
- Department of Intensive Care Unit, The Affilated Hospital of Qingdao University, Qingdao, China
| | - Jukun Song
- Department of Oral and MaxillofIcial Surgery, The Affiliated Stomatological Hospital of Guizhou Medical University, Guiyang, China
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Lai Y, Zhang Y, Cheng S, Mo S, Huang Y, Huang J, Zhang S, Lou Z, Li H, Li J, Liu X, Wang M. Exploring the Interaction Between HLA-B27 and Other Risk Factors of Valvular Heart Disease in Axial Spondyloarthritis. Int J Rheum Dis 2025; 28:e70157. [PMID: 40041948 DOI: 10.1111/1756-185x.70157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 02/18/2025] [Accepted: 02/21/2025] [Indexed: 05/12/2025]
Abstract
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.
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Affiliation(s)
- Yupeng Lai
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yanpeng Zhang
- Department of Laboratory, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Shuo Cheng
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Shaozhen Mo
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Yihong Huang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jiaming Huang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Suo Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Zhongfeng Lou
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Haoliang Li
- Department of Cardiology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jing Li
- Department of Hematology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xingjiao Liu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Meiying Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
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Falconer JL, Rajani R, Androshchuk V, Yogarajah A, Greenbury RA, Ismail A, Oh N, Nibali L, D’Agostino EM, Sousa V. Exploring links between oral health and infective endocarditis. FRONTIERS IN ORAL HEALTH 2024; 5:1426903. [PMID: 39687478 PMCID: PMC11647013 DOI: 10.3389/froh.2024.1426903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 10/18/2024] [Indexed: 12/18/2024] Open
Abstract
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.
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Affiliation(s)
- Joseph Luke Falconer
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, United Kingdom
- Department of Periodontology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Vitaliy Androshchuk
- Department of Cardiology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Amieth Yogarajah
- Department of Anaesthesia, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Rebecca A. Greenbury
- Ealing Hospital, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Ayden Ismail
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, United Kingdom
| | - Natasha Oh
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, United Kingdom
| | - Luigi Nibali
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, United Kingdom
- Department of Periodontology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | | | - Vanessa Sousa
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, Kings College London, London, United Kingdom
- Department of Periodontology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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Nayak G, Dimitriadis K, Pyrpyris N, Manti M, Kamperidis N, Kamperidis V, Ziakas A, Tsioufis K. Gut Microbiome and Its Role in Valvular Heart Disease: Not a "Gutted" Relationship. Life (Basel) 2024; 14:527. [PMID: 38672797 PMCID: PMC11051562 DOI: 10.3390/life14040527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/07/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
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.
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Affiliation(s)
- Gyanaranjan Nayak
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (G.N.); (N.P.); (K.T.)
| | - Kyriakos Dimitriadis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (G.N.); (N.P.); (K.T.)
| | - Nikolaos Pyrpyris
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (G.N.); (N.P.); (K.T.)
| | - Magdalini Manti
- St Mark’s Hospital, Imperial College London, London HA1 3UJ, UK (N.K.)
| | | | - Vasileios Kamperidis
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54453 Thessaloniki, Greece; (V.K.); (A.Z.)
| | - Antonios Ziakas
- First Cardiology Department, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 54453 Thessaloniki, Greece; (V.K.); (A.Z.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (G.N.); (N.P.); (K.T.)
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Neculae E, Gosav EM, Valasciuc E, Dima N, Floria M, Tanase DM. The Oral Microbiota in Valvular Heart Disease: Current Knowledge and Future Directions. LIFE (BASEL, SWITZERLAND) 2023; 13:life13010182. [PMID: 36676130 PMCID: PMC9862471 DOI: 10.3390/life13010182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/31/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
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.
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Affiliation(s)
- Ecaterina Neculae
- Department of Gastroenterology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, “Sf. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania
| | - Evelina Maria Gosav
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania
| | - Emilia Valasciuc
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania
| | - Nicoleta Dima
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania
| | - Mariana Floria
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania
- Correspondence:
| | - Daniela Maria Tanase
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania
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Li L, Wang M, Bao J, Wang N, Huang Y, He S, Chen B, Yan F. Periodontitis may impair the homeostasis of systemic bone through regulation of gut microbiota in
ApoE
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mice. J Clin Periodontol 2022; 49:1304-1319. [PMID: 35871602 DOI: 10.1111/jcpe.13708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/01/2022] [Accepted: 07/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lili Li
- Department of Periodontology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
- Central laboratory of Stomatology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
| | - Min Wang
- Department of Periodontology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
- Central laboratory of Stomatology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
| | - Jun Bao
- Department of Periodontology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
- Central laboratory of Stomatology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
| | - Nannan Wang
- Department of Periodontology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
- Central laboratory of Stomatology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
| | - Yuezhen Huang
- Department of Periodontology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
- Central laboratory of Stomatology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
| | - Shasha He
- Department of Periodontology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
- Central laboratory of Stomatology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
| | - Bin Chen
- Department of Periodontology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
- Central laboratory of Stomatology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
| | - Fuhua Yan
- Department of Periodontology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
- Central laboratory of Stomatology, Nangjing Stomatological Hospital Medical School of Nanjing University Nanjing Jiangsu P.R. China
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Chang R, Hung YM, Wei JCC. Correspondence on "Time-dependent Analysis of Risk of New-onset Heart Failure among Patients with Polymyositis and Dermatomyositis". Arthritis Rheumatol 2021; 74:730. [PMID: 34807512 DOI: 10.1002/art.42025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Min Hung
- College of Health and Nursing, Meiho University, Pingtung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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