Periodontal Status in Acute Coronary Syndrome Patients: Pilot Study

Objective: To assess the periodontal status and level of systemic inflammation in acute coronary syndrome (ACS) patients. Rationale: A link between periodontitis and cardiovascular disease (CVD) has been demonstrated. Methods: Patients previously diagnosed with ACS were recruited into the study an average of 9 months after discharge. Blood samples were collected for biomarker hs C-reactive protein (hsCRP) analysis. Mouth rinse samples have been stored for future analysis of inflammatory biomarkers. Full mouth periodontal examination including pocket depth (PD), clinical attachment levels (CAL), bleeding on probing (BOP), and tooth mobility was performed. Results: 15 patients (age: 32-89 years) were enrolled. Blood hsCRP levels ranged from 0.94 to 12.6 mg/L (mean 3.47 mg/L). 14 out of 15 patients had hsCRP levels > 1 mg/L. When their periodontal status was assessed by CAL, 100% of patients demonstrated moderate (66.7%) to severe ( 33.3%) periodontal disease [ie., > 30% of all sites showed evidence of periodontitis, and severity was categorized as slight (1-2 mm CAL), moderate (3-4 mm CAL), or severe ( ≥5 mm CAL)]. Patients with hsCRP > 3mg/L were 2.3 times more likely to have severe periodontitis than patients with hsCRP <3 mg/L. Conclusion: In this pilot study, 92% of patients were moderate (1-3 mg/L) to high risk (> 3 mg/L) for CVD based on their hsCRP levels in spite of statin therapy. 100% of ACS patients examined in this study demonstrated moderate to severe periodontitis, which appeared to be higher than the rate described for the general population (ie., 44% incidence). There is a trend towards a positive correlation between severe periodontitis and blood hsCRP levels. Larger patient sample size is needed for further evaluation. Supported by NYSTAR grant # A43273 from Center of Advanced Biotechnology, Stony Brook University; and GCRC, School of Medicine, Stony Brook University.