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Is periodontal infection behind the failure of antibiotics to prevent
coronary events?

Paju et al., Atherosclerosis, Vol. 193, Issue 1, pp. 193-95 (July
2007)

The use of antimicrobial agents to prevent coronary events is under
debate. They have reduced cardiovascular events in some studies, but
in others, their effect has not been distinguishable from that of
placebo. In addition to Chlamydophila (Chlamydia) pneumoniae as a
target pathogen, very few other microbes or infections have been
targeted, although an association for instance between cardiovascular
disease and periodontitis has been established. In our recent pilot
study, long-term clarithromycin treatment reduces recurrent
cardiovascular events in subjects without periodontitis, but in
subjects with periodontitis, fails to show any effect. As a background
infection, periodontitis may overpower the beneficial effects of
antibiotics. This paper presents the hypothesis that periodontitis is
behind the failure of antibiotics to prevent coronary events. We
discuss the systemic effects of periodontal infection and consider
studies to test our hypothesis, which offers a novel viewpoint for
discussion of antibiotics in coronary-disease prevention.

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Interesting hypothesis.
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Systemic exposure to Porphyromonas gingivalis predicts incident stroke
Atherosclerosis, Vol. 193, Issue 1, 222-228 (July 2007)

Periodontitis has been associated with an increased risk for
atherosclerosis. Prospective data concerning its association with risk
of stroke, especially those measuring systemic exposure to periodontal
pathogens, are scarce. We analyzed if serum antibody levels to two
major periodontopathogens predict stroke.

The cases and the controls were nested in a random population-based
sample of 8911 subjects aged 30-59 years at baseline, who participated
in a cardiovascular disease (CVD) risk factor survey in Eastern
Finland in 1977 and were followed for 15 years. CVD-free controls
(n=516) were matched for sex and 5-year age group with stroke cases
(n=470).

In subjects free from CVD at baseline (n=893), systemic exposure to
Porphyromonas gingivalis increased the risk of stroke: compared to
seronegative subjects, men IgA-seropositive and women IgG-seropositive
for P. gingivalis had a multivariate odds ratio (OR) (95% CI) of 1.63
(1.06-2.50) and 2.30 (1.39-3.78) for stroke, respectively. Higher OR
was observed in males, who had never smoked: compared to seronegative
men, P. gingivalis IgA-seropositive men had a multivariate OR of 3.31
(1.31-8.40, p=0.012) for stroke. No association between antibody
levels to Actinobacillus actinomycetemcomitans and stroke was found.

The results suggest that the systemic exposure to P. gingivalis may
predispose to incident stroke.

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There was a study published in the March 1, 2007 issue of the NEJM
that compared intensive treatment by periodontists with less intensive
treatment. The intensive treatment group had a short term increase in
endothelial dysfunction but improvement in endothelial function six
months out. I notice that the American Academy of Periodontology
highlights this study on its website. This seems like an area where
more research is needed.
It remains wise to get rid of all sources of inflammation especially