Chronic periodontitis is associated with lacunar infarct: a case–control study
Corresponding Author
Y. Leira
Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Correspondence: Dr Y. Leira, Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Rúa Entrerríos S/N, 15782 Santiago de Compostela, Spain (tel.: +34 626770986; fax: +34 981580243; e-mail: [email protected]).Search for more papers by this authorI. López-Dequidt
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorS. Arias
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorM. Rodríguez-Yáñez
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorR. Leira
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorT. Sobrino
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorF. Campos
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorM. Blanco
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorJ. Blanco
Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorJ. Castillo
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorCorresponding Author
Y. Leira
Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Correspondence: Dr Y. Leira, Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Rúa Entrerríos S/N, 15782 Santiago de Compostela, Spain (tel.: +34 626770986; fax: +34 981580243; e-mail: [email protected]).Search for more papers by this authorI. López-Dequidt
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorS. Arias
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorM. Rodríguez-Yáñez
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorR. Leira
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorT. Sobrino
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorF. Campos
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorM. Blanco
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorJ. Blanco
Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorJ. Castillo
Department of Neurology, Neurovascular Area, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
Search for more papers by this authorAbstract
Background and purpose
Chronic periodontitis (ChP) and lacunar infarct (LI) are two common diseases amongst the elderly. Although several studies have shown an association between ischaemic stroke and ChP, little is known about the relationship between ChP and LI. The study aims to investigate whether ChP is associated with the presence of lacunar stroke.
Methods
An age- and gender-matched case–control study of 62 cases (subjects diagnosed with LI) and 60 controls is reported. Clinical periodontal measures (probing pocket depth, recession, clinical attachment level, full mouth plaque score and full mouth gingival bleeding on probing score) were assessed, and associated risk factors for periodontitis and lacunar stroke were ascertained by means of a structured questionnaire.
Results
Chronic periodontitis showed a strong association with LI after adjusting for common vascular risk factors (odds ratio 4.20; 95% confidence interval 1.81–10.20; P = 0.001). Likewise, severe ChP and LI also tended to be significantly associated, independent of other vascular covariates (odds ratio 3.53; 95% confidence interval 1.07–12.77; P = 0.04).
Conclusions
Chronic periodontitis was independently associated with the presence of LI after adjusting for well-known vascular risk factors for lacunar stroke. Further observational studies are necessary to investigate the pathophysiological mechanisms that can explain this relationship.
References
- 1Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke 1999; 30: 2513–2516.
- 2Davis SM, Donnan GA. Why lacunar syndromes are different and important. Stroke 2004; 35: 1780–1781.
- 3Wardlaw JM. What causes lacunar stroke? J Neurol Neurosurg Psychiatr 2005; 76: 617–619.
- 4Fisher CM. Capsular infarcts: the underlying vascular lesions. Arch Neurol 1979; 36: 65–73.
- 5Newby DE, McLeod AL, Uren NG, et al. Impaired coronary tissue plasminogen activator release is associated with coronary atherosclerosis and cigarette smoking: direct link between endothelial dysfunction and atherothrombosis. Circulation 2001; 3: 1936–1941.
10.1161/01.CIR.103.15.1936 Google Scholar
- 6Knottnerus ILH, Ten Cate H, Lodder J, Kessels F, van Oostenbrugge RJ. Endothelial dysfunction in lacunar stroke: a systematic review. Cerebrovasc Dis 2009; 27: 519–526.
- 7Stevenson SF, Doubal FN, Shuler K, Wardlaw JM. A systematic review of dynamic cerebral and peripheral endothelial function in lacunar stroke versus controls. Stroke 2010; 41: 434–442.
- 8Sheiham A, Netuveli G. Periodontal diseases in Europe. Periodontol 2000 2002; 29: 104–121.
- 9Bartold PM, Van Dyke TE. Periodontitis: a host-mediated disruption of microbial homeostasis. Unlearning learned concepts. Periodontol 2000 2013; 62: 203–217.
- 10Papapanou PN. Periodontal diseases: epidemiology. Ann Periodontol 1996; 1: 1–36.
- 11Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol 2008; 35: 277–290.
- 12Schenkein HA, Loos BG. Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J Clin Periodontol 2013; 40(Suppl. 14): S51–S69.
- 13Gurav AN. The implication of periodontitis in vascular endothelial dysfunction. Eur J Clin Invest 2014; 44: 1000–1009.
- 14Reyes L, Herrera D, Kozarov E, Roldán S, Progulske-Fox A. Periodontal bacterial invasion and infection: contribution to atherosclerotic pathology. J Clin Periodontol 2013; 40(Suppl. 14): S30–S50.
- 15Grau AJ, Becher H, Ziegler CM, et al. Periodontal disease as a risk factor for ischemic stroke. Stroke 2004; 35: 496–501.
- 16Dörfer CE, Becher H, Ziegler CM, et al. The association of gingivitis and periodontitis with ischemic stroke. J Clin Periodontol 2004; 31: 396–401.
- 17Pradeep AR, Hadge P, Arjun Raju P, Shetty SR, Shareef K, Guruprasad CN. Periodontitis as a risk factor for cerebrovascular accident: a case−control study in the Indian population. J Periodontal Res 2010; 45: 223–228.
- 18Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol 1996; 67: 1123–1137.
- 19Wu T, Trevisan M, Genco RJ, Dorn JP, Falkner KL, Sempos CT. Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study. Arch Intern Med 2000; 160: 2749–2755.
- 20Jimenez M, Krall EA, Garcia RI, Vokonas PS, Dietrich T. Periodontitis and incidence of cerebrovascular disease in men. Ann Neurol 2009; 66: 505–512.
- 21Hachinski V. World Stroke Day 2008: ‘little strokes, big trouble’. Stroke 2008; 39: 2407–2420.
- 22Blanco M, Castellanos M, Rodríguez-Yáñez M, et al. High blood pressure and inflammation are associated with poor prognosis in lacunar infarction. Cerebrovasc Dis 2006; 22: 123–129.
- 23Vermeer SE, Prins ND, den Heijer T, Hofman A, Koudstaal PJ, Breteler MMB. Silent brain infarcts and the risk of dementia and cognitive decline. N Engl J Med 2003; 348: 1215–1222.
- 24Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344–349.
- 25Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definition for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35–41.
- 26O'Leary TJ, Drake RB, Naylor JE. The plaque control record. J Periodontol 1972; 43: 38.
- 27Ainamo J, Bay I. Problems and proposals for recording gingivitis and plaque. Int Dent J 1975; 25: 229–235.
- 28Eke PI, Page RC, Wei L, Thornton-Evans G, Genco R. Update of the case definitions for population-based surveillance of periodontitis. J Periodontol 2012; 83: 1449–1454.
- 29Bamford J, Sandercock P, Jones L, Warlow C. The natural history of lacunar infarction: the Oxfordshire Community Stroke Project. Stroke 1987; 18: 545–551.
- 30Fisher CM. Lacunar strokes and infarcts: a review. Neurology 1982; 32: 871–876.
- 31Fazekas F, Kleinert R, Offenbacher H, et al. Pathologic correlates of incidental MRI white matter signal hyperintensities. Neurology 1993; 43: 1683–1689.
- 32Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim carotid intima-media thickness consensus (2004−2006). An update on behalf of the Advisory Board of the 3rd and 4th Watching the Risk Symposium, 13th and 15th European Stroke Conferences, Mannheim, Germany, 2004, and Brussels, Belgium, 2006. Cerebrovasc Dis 2007; 23: 75–80.
- 33Taguchi A, Miki M, Muto A, et al. Association between oral health and the risk of lacunar infarction in Japanese adults. Gerontology 2013; 59: 499–506.
- 34Allen CL, Bayraktutan U. Risk factors for ischaemic stroke. Int J Stroke 2008; 3: 105–116.
- 35Bezerra DC, Sharrett AR, Matsushita K, et al. Risk factors for lacune subtypes in the Atherosclerosis Risk in Communities (ARIC) Study. Neurology 2012; 78: 102–108.
- 36Van Dijk EJ, Prins ND, Vrooman HA, Hofman A, Koudstaal PJ, Breteler MM. Progression of cerebral small vessel disease in relation to risk factors and cognitive consequences: Rotterdam Scan study. Stroke 2008; 39: 2712–2719.
- 37Blanco M, Nombela F, Castellanos M, et al. Statin treatment withdrawal in ischemic stroke: a controlled randomized study. Neurology 2007; 69: 904–910.
- 38Sobrino T, Blanco M, Pérez-Mato M, Rodríguez-Yáñez M, Castillo J. Increased levels of circulating endothelial progenitor cells in patients with ischaemic stroke treated with statins during acute phase. Eur J Neurol 2012; 19: 1539–1546.
- 39Suvan J, Petrie A, Nibali L, et al. Association between overweight/obesity and increased risk of periodontitis. [published online ahead of print 9 June 2015]. J Clin Periodontol 2015; 42: 733–739.
- 40Tonetti MS, D'Aiuto F, Nibali L, et al. Treatment of periodontitis and endothelial function. N Engl J Med 2007; 356: 911–920.