Periodontal Pathogens, MMP-9, TIMP-1 and Atherosclerosis in Periodontitis Patients

Objectives:The purpose was to study the involvement of periodontitis in atherosclerosis.Methods:In randomly chosen 82 patients with periodontitis and 31 periodontally healthy individuals subjected to a clinical oral examination in 1985, and re-examined 2003, samples were collected from the periodontal test sites to detect the presence or absence of Actinobacillus actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Prevotella nigresence (P.n.), and Tannerella forsythensis (T.f.). Matrix metalloproteinase-9(MMP-9), tissue inhibitor matrix metalloproteinase-1(TIMP-1), and total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides were assayed in plasma and carotid ultrasonography was performed during re-examination 16 years later. Common carotid artery intima-media thickness (IMT), and intima media area (cIMA) were calculated. The relationship between IMT, cIMA and MMP-9, TIMP-1 and MMP-9/TIMP- as dependent variables and several independent variables were evaluated in a multiple logistic regression model. Results:All micro organisms tested were present in both groups but significantly more patients had P.g., P.i., and T.f. than controls. Patients with simultaneous presence of P.g. and T.f. had significantly more MMP-9 in GCF as well as in blood. Total cholesterol, LDL-cholesterol, triglycerides, MMP-9, TIMP-1, IMT and cIMA were significantly higher in patients than controls. When the two ultrasonographic variables were tested, multiple logistic regression analysis identified periodontitis as a principal independent predictor of for the common artery IMT (OR, 7.07; P=0.001, 95% confidence interval 2.13-23.45) and cIMA (OR 6.99, P=0.003, 95% confidence interval 1.93 – 25.31), and when MMP-9, TIMP-1, and MMP-9/TIMP-1 were tested in the same model periodontitis was identified as a principal independent predictor for MMP-9, (OR, 5.21; P=0.003, 95% confidence interval 1.7 –15.45), TIMP-1(OR, 8.22; P=0.001, 95% confidence interval 2.50- 27.91), and MMP-9/TIMP-1(OR,4.66; P=0.005, 95% confidence interval 1.61 -13.49). Conclusions:These results suggest that increased MMP-9 may represent a possible link between periodontitis and atherosclerosis and a risk marker for both diseases.