hrcak mascot   Srce   HID

Izvorni znanstveni članak
https://doi.org/10.15644/asc49/1/2

Povezanost parodontne bolesti s angiografski dokazanom koronarnom arterijskom bolesti

Domagoj Vražić ; Zavod za parodontologiju Stomatološkog fakulteta Sveučilišta u Zagrebu, Hrvatska; Klinički zavod za parodontologiju Kliničkog bolničkog centra Zagreb, Hrvatska
Zoran Miovski ; Klinika za bolesti srca i krvnih žila Kliničkog bolničkog centra Zagreb, Hrvatska
Maja Strozzi ; Klinika za bolesti srca i krvnih žila Kliničkog bolničkog centra Zagreb, Hrvatska
Ivan Puhar ; Zavod za parodontologiju Stomatološkog fakulteta Sveučilišta u Zagrebu, Hrvatska; Klinički zavod za parodontologiju Kliničkog bolničkog centra Zagreb, Hrvatska
Ana Badovinac ; Zavod za parodontologiju Stomatološkog fakulteta Sveučilišta u Zagrebu, Hrvatska; Klinički zavod za parodontologiju Kliničkog bolničkog centra Zagreb, Hrvatska
Darko Božić ; Zavod za parodontologiju Stomatološkog fakulteta Sveučilišta u Zagrebu, Hrvatska; Klinički zavod za parodontologiju Kliničkog bolničkog centra Zagreb, Hrvatska
Darije Plančak ; Zavod za parodontologiju Stomatološkog fakulteta Sveučilišta u Zagrebu, Hrvatska; Klinički zavod za parodontologiju Kliničkog bolničkog centra Zagreb, Hrvatska

Puni tekst: hrvatski, pdf (207 KB) str. 14-20 preuzimanja: 231* citiraj
APA 6th Edition
Vražić, D., Miovski, Z., Strozzi, M., Puhar, I., Badovinac, A., Božić, D. i Plančak, D. (2015). Povezanost parodontne bolesti s angiografski dokazanom koronarnom arterijskom bolesti. Acta stomatologica Croatica, 49 (1), 14-20. https://doi.org/10.15644/asc49/1/2
MLA 8th Edition
Vražić, Domagoj, et al. "Povezanost parodontne bolesti s angiografski dokazanom koronarnom arterijskom bolesti." Acta stomatologica Croatica, vol. 49, br. 1, 2015, str. 14-20. https://doi.org/10.15644/asc49/1/2. Citirano 29.09.2020.
Chicago 17th Edition
Vražić, Domagoj, Zoran Miovski, Maja Strozzi, Ivan Puhar, Ana Badovinac, Darko Božić i Darije Plančak. "Povezanost parodontne bolesti s angiografski dokazanom koronarnom arterijskom bolesti." Acta stomatologica Croatica 49, br. 1 (2015): 14-20. https://doi.org/10.15644/asc49/1/2
Harvard
Vražić, D., et al. (2015). 'Povezanost parodontne bolesti s angiografski dokazanom koronarnom arterijskom bolesti', Acta stomatologica Croatica, 49(1), str. 14-20. https://doi.org/10.15644/asc49/1/2
Vancouver
Vražić D, Miovski Z, Strozzi M, Puhar I, Badovinac A, Božić D i sur. Povezanost parodontne bolesti s angiografski dokazanom koronarnom arterijskom bolesti. Acta stomatologica Croatica [Internet]. 2015 [pristupljeno 29.09.2020.];49(1):14-20. https://doi.org/10.15644/asc49/1/2
IEEE
D. Vražić, et al., "Povezanost parodontne bolesti s angiografski dokazanom koronarnom arterijskom bolesti", Acta stomatologica Croatica, vol.49, br. 1, str. 14-20, 2015. [Online]. https://doi.org/10.15644/asc49/1/2
Puni tekst: engleski, pdf (207 KB) str. 14-20 preuzimanja: 228* citiraj
APA 6th Edition
Vražić, D., Miovski, Z., Strozzi, M., Puhar, I., Badovinac, A., Božić, D. i Plančak, D. (2015). Periodontal Disease and its Association with Angiographically Verified Coronary Artery Disease. Acta stomatologica Croatica, 49 (1), 14-20. https://doi.org/10.15644/asc49/1/2
MLA 8th Edition
Vražić, Domagoj, et al. "Periodontal Disease and its Association with Angiographically Verified Coronary Artery Disease." Acta stomatologica Croatica, vol. 49, br. 1, 2015, str. 14-20. https://doi.org/10.15644/asc49/1/2. Citirano 29.09.2020.
Chicago 17th Edition
Vražić, Domagoj, Zoran Miovski, Maja Strozzi, Ivan Puhar, Ana Badovinac, Darko Božić i Darije Plančak. "Periodontal Disease and its Association with Angiographically Verified Coronary Artery Disease." Acta stomatologica Croatica 49, br. 1 (2015): 14-20. https://doi.org/10.15644/asc49/1/2
Harvard
Vražić, D., et al. (2015). 'Periodontal Disease and its Association with Angiographically Verified Coronary Artery Disease', Acta stomatologica Croatica, 49(1), str. 14-20. https://doi.org/10.15644/asc49/1/2
Vancouver
Vražić D, Miovski Z, Strozzi M, Puhar I, Badovinac A, Božić D i sur. Periodontal Disease and its Association with Angiographically Verified Coronary Artery Disease. Acta stomatologica Croatica [Internet]. 2015 [pristupljeno 29.09.2020.];49(1):14-20. https://doi.org/10.15644/asc49/1/2
IEEE
D. Vražić, et al., "Periodontal Disease and its Association with Angiographically Verified Coronary Artery Disease", Acta stomatologica Croatica, vol.49, br. 1, str. 14-20, 2015. [Online]. https://doi.org/10.15644/asc49/1/2

Rad u XML formatu

Sažetak
Uvod: Svrha ovog istraživanja bila je ispitati povezanost agresivnoga i kroničnog parodontitisa
s težinom koronarne arterijske bolesti potvrđene koronarnom angiografijom. Materijal i metode:
Ispitanici su bili hospitalizirani bolesnici Kliničkoga bolničkog centra Zagreb kojima je zbog
boli u prsima obavljena koronarna angiografija. Temeljiti klinički pregled sastojao se od bilježenja
parodontoloških indeksa te kliničkih i socijalno-demografskih parametara. Ispitanici su bili
podijeljeni u dvije skupine: ispitivanu – u njoj su sudjelovali bolesnici s akutnim koronarnim sindromom
(ACS-om) i stabilnom koronarnom arterijskom bolesti (CAD-om) i kontrolnu – s ispitanicima
bez značajne koronarne arterijske bolesti. Podatci su analizirani Kruskal-Wallisovim i Pearsonovim
hi-kvadrat testom. Rezultati: Od 106 ispitanika njih 66 (62,3 %) hospitalizirani su zbog
ACS-a, a 22 (20,7 %) zbog stabilnoga CAD-a. Samo 18 sudionika u ispitivanju (17,0 %) nije imalo
značajni CAD. Od ukupnoga broja bolesnika – 106, samo njih 26 (24,5 %) nikad nisu bili pušači
(p < 0,05). Kronični parodontitis najčešći je nalaz u obje ispitivane skupine – 68,2 posto u skupini
s ACS-om i 54,5 posto u onoj sa stabilnim CAD-om, a najviše zdravih pacijenta bez parodontitisa
(72,6 %) bilo je u kontrolnoj skupini (p < 0,001). Skupina sa stabilnim CAD-om imala je najvišu
srednju vrijednost dubine sondiranja (PD) 3,92 ± 1,16, recesije gingive (GR) 1,34 ± 0,78, razine
kliničkog pričvrstka (CAL) 4,60 ± 1,41 i krvarenja pri sondiranju (BOP) 45,98 ± 26,19. U skupini s
ACS-om PD je bio 3,77 ± 0,91, GR 1,11 ± 0,66, CAL 4,32 ± 1,08 i BOP 41,30 ± 22,09, a u kontrolnoj
skupini izmjeren je PD 3,27 ± 0,97, GR 0,69 ± 0,37, CAL 3,62 ± 1,04 i BOP 26,39 ± 13,92 (p <
0,05). Zaključak: Parodontitis je povezan s angiografski potvrđenom koronarnom arterijskom bolesti.
Kod bolesnika s ACS-om i stabilnim CAD-om zabilježeni su tjelesna neaktivnost, loša oralna
higijena i parodontna upala.

Ključne riječi
parodontitis; parodontalni indeks; kardiovaskularne bolesti; bolesti koronarne arterije; koronarna angiografija

Hrčak ID: 136813

URI
https://hrcak.srce.hr/136813

▼ Article Information



Introduction

Periodontitis is a chronic inflammatory disease which is induced by microorganisms and results in destruction of tooth supporting structures. Being a multifactorial disease, it shares certain risk factors with other systemic diseases, such as cardiovascular diseases (CVD) (1, 2), diabetes (3, 4) and other systemic diseases such as chronic obstructive pulmonary disease, rheumatoid arthritis and metabolic syndrome (5). Affecting more than 47% of the population (6), it can be said that it is a common disease. Coronary artery disease (CAD) is the most common type of heart disease as well and it is the leading cause of death globally, with an estimated 17.3 million people who died from CVD in 2008 representing 30% of all global deaths, of which an estimated 7.3 million were due to coronary heart disease (CHD) (7). The impact of periodontitis on CAD is likely to occur with the entry of bacteria and its products from oral cavity into the bloodstream (8, 9). The activation of host inflammatory response contributes to the atheroma formation, followed by maturation and finally exacerbation which results in formation of blood cloth (thrombus) leading to CHD. Common risk factors such as diabetes mellitus, smoking, genetics, stress, depression, physical inactivity and obesity make it difficult to positively associate periodontitis and CHD (10, 11). However, studies have shown such association regardless of common risk factors to be possible (12-14). Moreover, recent meta-analyses established periodontitis as a risk factor, or as a marker independent of traditional CAD risk factors, for CHD with relative risks ranging from 1.24 to 1.35 (15).

The aim of this research was to investigate the association of periodontitis, both chronic and aggressive form, with the severity of coronary artery disease which was verified angiographically during the patient’s hospitalization.

Materials and Methods

Subjects were selected from hospitalized patients at the University Hospital Centre Zagreb, Croatia. Coronary angiography was performed in patients with chest pain using transfemoral or transradial approach. We performed thorough clinical examination which included body mass index (BMI), physical activity, smoking status, education level, number of teeth, as well as the following periodontal indices: plaque index (PI), bleeding on probing (BOP), periodontal probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). Periodontal indices were performed by a single periodontology specialist and measured using dental mirror and a standard periodontal probe (PCP-15, Hu-Friedy, Chicago, IL, USA), with prior training and calibration of the examiner. Subjects who were submitted to coronary angiography and had at least 20 teeth in their mouth were included in the study. Patients were also required to fill in a Croatian version of SF-36 Health Survey questionnaire regarding general quality of life assessment (16, 17). Based on the result of the angiography, we divided the examined patients in two test groups: acute coronary syndrome (ACS) test group, which included patients with instable angina pectoris, ST elevation myocardial infarction, non ST elevation myocardial infarction, and stable CAD test group. We had one control group which included subjects who had normal coronary angiography or had no significant CAD (stenoses of coronary arteries were less than 50%). Data were analyzed using Kruskal-Wallis and Pearson’s Chi-Square test. P values below 0.05 were considered significant. Software used for data analysis was IBM SPSS Statistics version 21.0. (SPSS Inc., Chicago, IL, USA). This research was approved by the Ethics Committee of School of Dental Medicine, University of Zagreb and by the Ethics Committee of University Hospital Centre Zagreb. Patients were given a choice of participation, all the required information regarding the research and a written consent.

Results

Out of 106 subjects who were examined, 66 (62.3%) were hospitalized for ACS, 22 (20.7%) had stable CAD and only 18 (17.0%) had no significant CAD (Table 1). Median (interquartile range) for age in ACS group was 51.0 (45.0-59.0) years, for stable CAD group 57.0 (49.0-60.0) years and for no significant CAD group 51.0 (48.0-59.0) years with no significant difference between groups. Median BMI for ACS group was 29.4 (27.0-32.2) kg/m2, for stable CAD group it was 30.0 (27.8-33.5) kg/m2 and for no significant CAD group it was 28.2 (25.2-29.7) kg/m2. Median physical activity for ACS group was 1.0 (0.0-3.0), for stable CAD group 1.0 (0.0-3.0) and for no significant CAD group it was 0.5 (0.0-3.0). General quality of life assessment showed no statistical significance in any of the groups. The education level of examined patients showed significance between the groups, with high education level being most dominant in ACS group (40%) and middle education level in no significant CAD group (72.2%) (p<0.05). ACS group had the highest mean value of lifetime tobacco exposure called pack years of 16.85 ± 23.13, stable CAD group had 13.68 ± 22.97 and no significant CAD group had a much less value of 5.00 ± 10.85. Only 26 (24.5%) out of 106 patients were never smokers, 42.4% were smokers and 24.5% were previous smokers (p<0.05). In ACS group alone, 33 out of 66 patients were smokers (50.0%), in stable CAD group previous smokers were dominant with 45.5% and in no significant CAD group never-smokers had the highest population of 55.6% with significance between the groups (p<0.05). Out of 106 patients in total, 69 (65.1%) were diagnosed with periodontitis. Chronic periodontitis was the most common finding in the two test groups, with 68.2% in ACS group and 54.5% in patients with stable CAD, while in the control group with no significant CAD the most common finding were healthy patients without periodontitis (72.6%), it was significant between the groups (p<0.001) (Figure 1). Stable CAD group had the highest mean PD (3.92 ± 1.16), GR (1.34 ± 0.78) and CAL (4.60 ± 1.41) values, whereas ACS group had mean PD value of 3.77 ± 0.91, GR 1.11 ± 0.66 and CAL 4.32 ± 1.08, and no significant CAD group had mean PD value of 3.27 ± 0.97, GR 0.69 ± 0.37 and CAL 3.62 ± 1.04 (Table 2). These periodontal indices showed statistical significance between the groups (p<0.05), as well as BOP whose mean value for ACS group was 41.30 ± 22.09, stable CAD group 45.98 ± 26.19 and no significant CAD group 26.39 ± 13.92 (p<0.05). Only PI did not show significance between the groups, with mean value for ACS group 58.44 ± 20.99, stable CAD group 57.45 ± 20.82 and no significant CAD group 53.67 ± 18.61.

Table 1 Clinical and socio-demographic characteristics of participants

DiagnosisP
ACS
N=65
stabile CAD
N=22
no significant CAD
N=18
Gender
Men: n (%)5787.7%1777.3%950.0%0.002
Women: n (%)
8
12.3%
5
22.7%
9
50.0%
SmokingNo: n (%)1218.5%418.2%1055.6%0.011
Yes: n (%)3350.8%836.4%422.2%
Ex: n (%)2030.8%1045.5%422.2%
Education Level
NSS: n (%)69.2%940.9%211.1%0.003
SSS (high school): n (%)3350.8%836.4%1372.2%
VŠS and VSS (college and university): n (%)
26
40.0%
5
22.7%
3
16.7%
Age (number of years): median (IQR)51.0(45.059.0)57.0(49.060.0)51.0(48.059.0)0.288
BMI (kg/m2): median (IQR)
29.4
(27.0
32.2)
30.0
(27.8
33.5)
28.2
(25.2
29.7)
0.247
Physical activity (times per week): median (IQR)1.0(0.03.0)1.0(0.03.0)0.5(0.03.0)0.439
Physical Functioning: median (IQR)
55.0
(45.0
70.0)
45.0
(35.0
70.0)
60.0
(45.0
80.0)
0.445
Role limitation due to Physical problems: median (IQR)25.0(0.075.0)12.5(0.075.0)37.5(25.075.0)0.368
Role limitation due to Emotional problems: median (IQR)
66.7
(33.3
100.0)
33.3
(0.0
66.7)
50.0
(0.0
100.0)
0.308
Social Functioning: median (IQR)62.5(50.075.0)62.5(50.075.0)56.3(37.575.0)0.575
Mental Health: median (IQR)
64.0
(52.0
72.0)
52.0
(44.0
76.0)
64.0
(56.0
76.0)
0.307
Energy Vitality: median (IQR)50.0(40.065.0)37.5(30.055.0)55.0(45.065.0)0.263
Pain: median (IQR)
50.0
(30.0
70.0)
40.0
(30.0
70.0)
50.0
(30.0
70.0)
0.933
General Health Perception: median (IQR)52.0(35.067.0)43.5(30.050.0)49.5(42.062.0)0.176
Figure 1 Periodontitis in relation to coronary artery disease: chi-square test, p<0.001
ASC_49(1)_14-20-f1
Table 2 Clinical characteristics

DiagnosisP
ACS
N=65
stabile CAD
N=22
no significant CAD
N=18
Number of teeth: median (IQR)
23.0(21.027.0)23.0(20.026.0)23.0(21.027.0)0.906
PI - plaque index (%): median (IQR)
63.0
(45.0
76.0)
56.0
(48.0
72.0)
52.0
(40.0
67.0)
0.538
BOP – bleeding on probing (%): median (IQR)
42.0(19.060.0)45.0(24.070.0)24.5(15.030.0)0.022
PD – probing depth (mm): median (IQR)
3.7
(3.0
4.4)
3.7
(3.1
4.6)
2.8
(2.7
3.5)
0.036
GR – gingival recession (mm): median (IQR)
1.0(0.61.6)1.2(0.61.7)0.6(0.41.0)0.015
CAL – clinical attachment level (mm): median (IQR)4.4(3.45.1)4.4(3.64.9)3.2(3.03.6)0.010

Discussion

Traditional risk factors for CHD are well known. They include male gender, age, smoking, dyslipidemia, obesity, diabetes, arterial hypertension and hereditary factors (18). Majority of subjects who were admitted to the hospital because of chest pain were largely male. In large epidemiological studies male gender is identified as risk factor for CAD (18). Age is also a risk factor for CAD, but it is also dependent on gender. Risk factor for CAD is over 45 years of age in males and 55 years in females (19). In our study, there were no significant age differences between the groups.

Smoking is another risk factor for CAD (18). As many as 30% of all CHD deaths worldwide each year are attributable to cigarette smoking, with the risk being strongly dose-related (20, 21). Smoking acts synergistically with other risk factors, substantially increasing the risk of CAD. As we expected, significantly more patients with acute coronary syndrome and stable CAD were smokers. Smoking is also a well-established risk factor for periodontitis (22).

Overweight is defined as a BMI of 25 to 29.9 kg/m2, obesity as a BMI of >30 kg/m2. Severe obesity is defined as a BMI >40 kg/m2. A number of large epidemiologic studies have evaluated the relationship between obesity and mortality (23). A large meta-analysis of 97 studies (2.88 million individuals) showed that being obese was associated with higher all-cause mortality (hazard ratio [HR] 1.18, 95% CI 1.12-1.25 for all grades of obesity combined) (24). In general, greater body mass index (BMI) is associated with increased rate of death from all causes and from CVD. The risk of all-cause mortality is increasing with BMI of 25 kg/m2 or higher. All groups of subjects had increased BMI, but there was no statistically significant difference between the groups, although individuals with no significant CAD had the lowest BMI value.

Probably due to a low number of patients examined we were not able to find any statistical significance in the general quality of life assessment, except marginally in one of eight fields of the questionnaire, role limitation due to physical problems (p=0.093).

The main findings of the present study showed that almost all measured periodontal indices have significant association between the groups, except PI which can be explained by poor oral hygiene during the stay in hospital. BOP, PD, GR and CAL were significantly higher in both ACS and stable CAD group. Based on these measures and clinical examination, we found that only 1/3 of examined patients were periodontally healthy, chi-square test p<0.001, (Figure 1). Recent systematic review of the association of clinically or radiographically diagnosed periodontal disease and CVD included six out of twelve studies on CHD and all but one study reported positive associations between periodontal disease and status measures and the incidence of CVD (25).

The prevention of CHD includes elimination of risk factors, with periodontitis being one of them (15). Several authors have examined the possibility that rigorous preventive and periodontal care is needed to reduce the cardiovascular risk (26) as well as to improve biomarkers and CVD outcomes (27) and that periodontal therapy has a positive effect in reducing serum C-reactive protein levels and improving the endothelial function (27, 28). Therefore, the diagnosis of periodontitis in population and its treatment and maintenance should be of utmost importance in order to reduce the risk for CHD.

Conclusion

This study showed that periodontitis is associated with angiographically verified coronary artery disease. Physical inactivity, poor oral hygiene and periodontal inflammation were observed in patients with ACS and stable CAD. Almost 2/3 of the examined patients had periodontitis and as such pose a risk for CAD development.

Acknowledgements

This paper was supported by the Ministry of Science, Education and Sports of the Republic of Croatia Grant No. 065-0650444-0415 (project leader Darije Plančak, project “Systemic aspects in the etiology of periodontal diseases”).

Notes

[1] Conflicts of interest The authors deny any conflicts of interest.

References

1 

Tonetti MS, Van Dyke TE. working group 1 of the joint EFPAAPw. Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol. 2013 Apr;84(4) Suppl:S24–9. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23631582

2 

Buhlin K, Mantyla P, Paju S, Peltola JS, Nieminen MS, Sinisalo J, et al. Periodontitis is associated with angiographically verified coronary artery disease. J Periodontol. 2013 Apr;84(4) Suppl:S24–9. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23631582

3 

Chapple IL, Genco R. Working group 2 of joint EFPAAPw. Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Clin Periodontol. 2013 Apr;40 Suppl 14:S106–12. DOI: http://dx.doi.org/10.1111/jcpe.12077 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23627322

4 

Genco RJ, Grossi SG, Ho A, Nishimura F, Murayama Y. A proposed model linking inflammation to obesity, diabetes, and periodontal infections. J Periodontol. 2005 Nov;76(11) Suppl:2075–84. DOI: http://dx.doi.org/10.1902/jop.2005.76.11-S.2075 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/16277579

5 

Linden GJ, Herzberg MC. working group 4 of the joint EFPAAPw. Periodontitis and systemic diseases: a record of discussions of working group 4 of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol. 2013 Apr;84(4) Suppl:S20–3. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23631580

6 

Borrell LN, Burt BA, Taylor GW. Prevalence and trends in periodontitis in the USA: the [corrected] NHANES, 1988 to 2000. J Dent Res. 2005 Oct;84(10):924–30. DOI: http://dx.doi.org/10.1177/154405910508401010 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/16183792

7 

Mendis S, Puska P, Norrving B, World Health Organization. World Heart Federation., World Stroke Organization. Global atlas on cardiovascular disease prevention and control. Geneva: World Health Organization in collaboration with the World Heart Federation and the World Stroke Organization; 2011. p. 155.

8 

Reyes L, Herrera D, Kozarov E, Roldan S, Progulske-Fox A. Periodontal bacterial invasion and infection: contribution to atherosclerotic pathology. J Clin Periodontol. 2013 Apr;40 Suppl 14:S30–50. DOI: http://dx.doi.org/10.1111/jcpe.12079 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23627333

9 

Schenkein HA, Loos BG. Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J Periodontol. 2013 Apr;84(4) Suppl:S51–69. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23631584

10 

Beck JD, Offenbacher S, Williams R, Gibbs P, Garcia R. Periodontitis: a risk factor for coronary heart disease? Ann Periodontol. 1998 Jul;3(1):127–41. DOI: http://dx.doi.org/10.1902/annals.1998.3.1.127 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/9722697

11 

Wu T, Trevisan M, Genco RJ, Falkner KL, Dorn JP, Sempos CT. Examination of the relation between periodontal health status and cardiovascular risk factors: serum total and high density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen. Am J Epidemiol. 2000 Feb 1;151(3):273–82. DOI: http://dx.doi.org/10.1093/oxfordjournals.aje.a010203 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/10670552

12 

Dietrich T, Jimenez M, Krall Kaye EA, Vokonas PS, Garcia RI. Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease. Circulation. 2008 Apr 1;117(13):1668–74. DOI: http://dx.doi.org/10.1161/CIRCULATIONAHA.107.711507 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/18362228

13 

Beck JD, Elter JR, Heiss G, Couper D, Mauriello SM, Offenbacher S. Relationship of periodontal disease to carotid artery intima-media wall thickness: the atherosclerosis risk in communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2001 Nov;21(11):1816–22. DOI: http://dx.doi.org/10.1161/hq1101.097803 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/11701471

14 

Desvarieux M, Demmer RT, Rundek T, Boden-Albala B, Jacobs DR Jr, Papapanou PN, et al. Relationship between periodontal disease, tooth loss, and carotid artery plaque: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Stroke. 2003 Sep;34(9):2120–5. DOI: http://dx.doi.org/10.1161/01.STR.0000085086.50957.22 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/12893951

15 

Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. J Gen Intern Med. 2008 Dec;23(12):2079–86. DOI: http://dx.doi.org/10.1007/s11606-008-0787-6 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/18807098

16 

Juresa V, Ivankovic D, Vuletic G, Babic-Banaszak A, Srcek I, Mastilica M, et al. The Croatian Health Survey--SF-36: I. General quality of life assessment. Coll Antropol. 2000;24(1):69–78. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/10895534

17 

Maslić Sersić D, Vuletic G. Psychometric evaluation and establishing norms of Croatian SF-36 health survey: framework for subjective health research. Croat Med J. 2006 Feb;47(1):95–102. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/16489702

18 

O'Donnell CJ, Elosua R. Cardiovascular risk factors. Insights from Framingham Heart Study. Rev Esp Cardiol. 2008 Mar;61(3):299–310. DOI: http://dx.doi.org/10.1157/13116658 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/18361904

19 

Wissler RW, Strong JP. Risk factors and progression of atherosclerosis in youth. PDAY Research Group. Pathological Determinants of Atherosclerosis in Youth. Am J Pathol. 1998 Oct;153(4):1023–33. DOI: http://dx.doi.org/10.1016/S0002-9440(10)65647-7 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/9777934

20 

Centers for Disease C. The Surgeon General's 1989 Report on Reducing the Health Consequences of Smoking: 25 Years of Progress. MMWR supplements. 1989 Mar 24;38 Suppl 2:1–32. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/2494426

21 

Centers for Disease C. Smokers' beliefs about the health benefits of smoking cessation--20 U.S. communities, 1989. MMWR Morb Mortal Wkly Rep. 1990 Sep 28;39(38):653–6. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/2118979

22 

Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol. 2004 Feb;75(2):196–209. DOI: http://dx.doi.org/10.1902/jop.2004.75.2.196 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/15068107

23 

Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, et al. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006 Aug 24;355(8):763–78. DOI: http://dx.doi.org/10.1056/NEJMoa055643 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/16926275

24 

Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA. 2013 Jan 2;309(1):71–82. DOI: http://dx.doi.org/10.1001/jama.2012.113905 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23280227

25 

Dietrich T, Sharma P, Walter C, Weston P, Beck J. The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Periodontol. 2013 Apr;84(4) Suppl:S70–84. PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23631585

26 

Offenbacher S, Beck JD, Moss K, Mendoza L, Paquette DW, Barrow DA, et al. Results from the Periodontitis and Vascular Events (PAVE) Study: a pilot multicentered, randomized, controlled trial to study effects of periodontal therapy in a secondary prevention model of cardiovascular disease. J Periodontol. 2009 Feb;80(2):190–201. DOI: http://dx.doi.org/10.1902/jop.2009.080007 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/19186958

27 

D'Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol. 2013 Apr;40 Suppl 14:S85–105. DOI: http://dx.doi.org/10.1111/jcpe.12061 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/23627337

28 

Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, et al. Treatment of periodontitis and endothelial function. N Engl J Med. 2007 Mar 1;356(9):911–20. DOI: http://dx.doi.org/10.1056/NEJMoa063186 PubMed: http://www.ncbi.nlm.nih.gov/pubmed/17329698


This display is generated from NISO JATS XML with jats-html.xsl. The XSLT engine is libxslt.

[engleski]

Posjeta: 747 *