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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  

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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