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Oral Disease as a Risk Factor for Acute Coronary Syndrome – Single Center Experience

Objective: Poor oral health is common in the United States. The incidence of periodontal disease in young adults in USA is around 7-10%.The current review finds that periodontal disease is associated with a 24% increase in the risk for CHD.

Background: Evidence for a link between periodontal disease and several systemic diseases is growing rapidly. Current evidence suggests that periodontitis is associated with an increased likelihood of coronary heart disease, diabetes and metabolic syndrome. In recent times there has been increasing awareness that immune responses are central to atherogenesis and a mechanism by which infection may initiate and facilitate the progression of atherosclerosis. The passage of periodontal pathogens, and their products, through ulcerated epithelium into the circulation, leading to bacteraemia and/or provocation of systemic immune and inflammatory responses is of concern. In a meta-analysis, periodontal disease increased the risk for incident CHD by a risk ratio of 1.24. Almost 1/3 of diabetes has severe periodontal disease.

Methods: A retrospective analysis was performed from January 2007 to December 2009 in all acute coronary syndromes admitted in Providence Hospital’s Heart Institute, who are less than 50 years old. Patient charts were reviewed. Patient’s demographics and traditional risk factors were charted. Patients were called and specific questions regarding periodontal disease were asked.

Results: A total of 130 patients were included in the analysis. 97 patients (70%) responded. The Patients were matched to the baseline demographics and traditional risk factors. Periodontal disease is found almost among 37% of patients in this study, which is approximately four and a half times the expected prevalence for this age group according to the findings of The National Health and Nutrition Examination Survey, 1999-2004. There is no increase in MACE events because of small sample size.

Conclusion: The mouth is, thus, a significant contributor to both the total burden of infection and inflammation and, hence, to overall health and well-being. The examination of the oralcavity is often neglected. Our findings support considering periodontal disease as a nontraditional risk factor for coronary artery disease and thus the implementation of screening for both primary and secondary prevention. We also recommend patient compliance with the American Dental Association recommendations regarding basic oral health.


Sachin Kumar Amruthlal Jain MD, Timothy Larsen DO, Michael Shaw PhD , Patrick Alexander MD and Shukri David MD

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