Periodontal Status, C-Reactive Protein, NT-proBNP, and Incident Heart Failure,JACC: Heart Failure

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Periodontal Status, C-Reactive Protein, NT-proBNP, and Incident Heart Failure
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2022-07-06 , DOI: 10.1016/j.jchf.2022.05.008
Rebecca L Molinsky ₁ , Melana Yuzefpolskaya ₂ , Faye L Norby ₃ , Bing Yu ₄ , Amil M Shah ₅ , James S Pankow ₁ , Chiadi E Ndumele ₆ , Pamela L Lutsey ₁ , Panos N Papapanou ₇ , James D Beck ₈ , Paolo C Colombo ₂ , Ryan T Demmer ₉

Affiliation

Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA; Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, California, USA.
Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA.
Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University, New York, New York, USA.
Division of Comprehensive Oral Health-Periodontology, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.

Background

Periodontal disease (PD), resulting from inflammatory host response to dysbiotic subgingival microbiota, has been linked to cardiovascular disease; however, its relationship to heart failure (HF) and its subtypes (heart failure with reduced ejection fraction [HFrEF] and heart failure with preserved ejection fraction [HFpEF]) is unexplored.

Objectives

The authors hypothesize that the presence of PD is associated with increased risk of incident HF, HFpEF, and HFrEF.

Methods

A total of 6,707 participants (mean age 63 ± 6 years) of the ARIC (Atherosclerosis Risk In Communities) study with full-mouth periodontal examination at visit 4 (1996-1998) and longitudinal follow-up for any incident HF (visit 4 to 2018), or incident HFpEF and HFrEF (2005-2018) were included. Periodontal status was classified as follows: healthy, PD (as per Periodontal Profile Classification [PPC]), or edentulous. Multivariable-adjusted Cox proportional hazards models were used to calculate HRs and 95% CIs for the association between PPC levels and incident HF, HFpEF, or HFrEF. Additionally, biomarkers of inflammation (C-reactive protein [CRP]) and congestion (N-terminal brain natriuretic peptide [NT-proBNP]) were assessed.

Results

In total, 1,178 incident HF cases occurred (350 HFpEF, 319 HFrEF, and 509 HF of unknown type) over a median of 13 years. Of these cases, 59% had PD, whereas 18% were edentulous. PD was associated with an increased risk for HFpEF (HR: 1.35 [95% CI: 0.98-1.86]) and significantly increased risk for HFrEF (HR: 1.69 [95% CI: 1.18-2.43]), as was edentulism: HFpEF (HR: 2.00 [95% CI: 1.37-2.93]), HFrEF (HR: 2.19 [95% CI: 1.43-3.36]). Edentulism was associated with unfavorable change in CRP and NT-proBNP, whereas PD was associated only with CRP.

Conclusions

Periodontal status was associated with incident HF, HFpEF, and HFrEF, as well as unfavorable changes in CRP and NT-proBNP.

中文翻译：

牙周状态、C 反应蛋白、NT-proBNP 和心力衰竭事件

背景

牙周病 (PD) 是由宿主对失调的龈下微生物群的炎症反应引起的，与心血管疾病有关。然而，其与心力衰竭 (HF) 及其亚型（射血分数降低的心力衰竭 [HFrEF] 和射血分数保留的心力衰竭 [HFpEF]）的关系尚未被探索。

目标

作者假设 PD 的存在与 HF、HFpEF 和 HFrEF 发生风险增加相关。

方法

ARIC（社区动脉粥样硬化风险）研究共有 6,707 名参与者（平均年龄 63 ± 6 岁），在第 4 次就诊时（1996-1998 年）进行了全口牙周检查，并对任何心衰事件进行了纵向随访（第 4 次就诊至2018 年），或事件 HFpEF 和 HFrEF（2005-2018 年）也包括在内。牙周状态分类如下：健康、PD（根据牙周轮廓分类[PPC]）或无牙颌。使用多变量调整的 Cox 比例风险模型来计算 PPC 水平与事件 HF、HFpEF 或 HFrEF 之间关联的 HR 和 95% CI。此外，还评估了炎症（C 反应蛋白 [CRP]）和充血（N 端脑钠尿肽 [NT-proBNP]）的生物标志物。

结果

中位数 13 年期间，总共发生了 1,178 例心力衰竭病例（350 例 HFpEF、319 例 HFrEF 和 509 例未知类型的心力衰竭）。在这些病例中，59% 患有 PD，而 18% 则无牙颌。 PD 与 HFpEF 风险增加相关（HR：1.35 [95% CI：0.98-1.86]），并且与 HFrEF 风险显着增加相关（HR：1.69 [95% CI：1.18-2.43]），无牙颌畸形也是如此：HFpEF（ HR：2.00 [95% CI：1.37-2.93]），HFrEF（HR：2.19 [95% CI：1.43-3.36]）。无牙颌与 CRP 和 NT-proBNP 的不利变化相关，而 PD 仅与 CRP 相关。

结论

牙周状态与 HF、HFpEF 和 HFrEF 事件以及 CRP 和 NT-proBNP 的不利变化相关。

更新日期：2022-07-06

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