Inflammatory response to acute coronary syndrome in patients with coexistent periodontal disease.

BACKGROUND: The inflammatory process that occurs in atherosclerotic plaque situated in the coronary vessel often leads to its destabilization, which in turn results in clot formation and the occurrence of acute coronary syndrome. Acute coronary syndromes (unstable angina, myocardial infarction) are among the leading causes of death in the human population. An inflammatory factor which leads to this process may be bacterial pathogens originating in the periodontal tissues. The aim of the study was to evaluate the influence of periodontal disease on the intensity and dynamics of the inflammatory response in patients with acute coronary syndrome and coexistent periodontal diseases.
METHODS: The study involved a group of 50 consecutive patients (nine females; 41 males) < or = 60 years of age (37 to 60; mean 51) with coronary pain and with an initial diagnosis of acute coronary syndrome admitted to the Coronary Care Unit of the Department of Cardiology. Dental examinations were carried out during the first 24 hours of hospitalization. Blood samples were taken at admission (examination 1), after 10 to 12 days of hospitalization (examination 2), 3 months after the acute coronary syndrome (examination 3), and, in some patients, 6 months after the acute episode (examination 4). This information was used to estimate the mean serum levels of interleukin-1 (IL-1) and tumor necrosis factor (TNF-alpha).
RESULTS: Chronic periodontitis was found in all patients. The patients were divided into two groups on the basis of periodontal disease and clinical attachment loss (CAL). The study showed raised mean values for TNF-alpha in examinations 2, 3, and 4 in patients with more advanced periodontal disease. There was also an increase in IL-1 concentration in the acute phase and in long-term observation (examination 3) in these patients. The patients with more advanced CAL had more pronounced periodontal disease and higher bleeding index values. All patients were characterized by high mean values of plaque index (46%) and bleeding index (80%).
CONCLUSIONS: The periodontal health of patients admitted to the Coronary Care Unit due to acute coronary syndrome is unacceptable. The mean values for CAL and probing depth, as well as extensive bleeding on probing sites indicate the presence of active periodontal disease, which may affect the incidence of cardiovascular disease. Although there were no significant differences in serum TNF-alpha or IL-1 levels in acute coronary disease patients with advanced periodontal disease compared to those with less advanced periodontal disease, we observed that patients with acute coronary syndrome and with more advanced periodontal disease tend to be characterized by higher mean values of serum concentrations of IL-1 in the acute phase of acute coronary syndrome, as well as in the long term, and of TNF-alpha in the long-term observation. Patients with less advanced periodontal disease were characterized by a faster diminution of the inflammatory response in comparison to the groups with more advanced periodontal disease.