High Dose Statin Reduces Periodontal Inflammation:Multi-Center Trial

Objective: Periodontitis is a risk factor for atherosclerosis. We previously showed, using  fluorodeoxyglucose positron emission tomography imaging  (FDG-PET), that periodontal inflammation correlates with carotid arterial inflammation. We recently demonstrated, in a multi-center clinical trial, that statin therapy is associated with dose-dependent reduction in atheroslerotic inflammation (assessed with FDG-PET-CT). Here we conduct a post-hoc, blinded analysis of the images derived from that trial to test the hypothesis that high dose statins (compared with low-dose) result in a reduction in periodontal inflammation.

Method: Adults with risk factors for established atherosclerosis, who were not on high-dose statin (n= 83, median age 59 yrs, range 37-78 yrs, 78% men) were randomized to 10 vs. 80mg of atorvastatin.  FDG-PET imaging was performed before and after 4 and 12 weeks statin therapy. Inflammation was assessed in periodontal tissues and carotids according to previously published techniques, FDG uptake normalized to blood pool activity, yielding a target to background ratio (TBR). All analyses were performed while blinded to time points and treatment.

Result: Data for analysis were available for 67 subjects. 12 weeks, the periodontal inflammation was significantly reduced in patients randomized to atorva 80 (vs. atorva 10) (change TBR=  - 0.30 ± 0.850 vs. 0.22 ± 0.68, atorva 80 vs. 10mg, mean ± SD, p=0.04,). Between-group differences became more substantial when patients without significant periodontal inflammation at baseline (lower tertile baseline periodontal TBR) were excluded, (change TBR= -0.52 ± 0.92 vs.  0.22 ± 0.79, atorva 80 vs. 10mg, P=0.009, figure). The differences were significant starting at 4 weeks.  The changes in periodontal inflammation correlated modestly with changes in carotid inflammation (p=0.001, r=0.45).

Conclusion: We observe reduction in periodontal inflammation in this first multi-center double-blinded trial evaluating effect of statins on FDG-PET measures of periodontal inflammation. Use of high dose statins might be beneficial for treatment of periodontitis.