Cardiovascular Disease

Cardiovascular disease encompasses a variety of conditions, that range from acute to chronic. According to the World Health Organization, cardiovascular diseases are a group of disorders that affect the heart and blood vessels (Table 2).64 The conditions that fall under the umbrella of cardiovascular disease include, but are not limited to, heart disease, heart attack, stroke, heart failure, arrhythmia, and problems with the heart valves.43

Table 2. Cardiovascular Diseases.64
Coronary Heart Disease Disease affects blood vessels that supply heart muscles
Cerebrovascular Disease Disease of blood vessels supplying brain
Peripheral Arterial Disease Disease of blood vessels supplying arms & legs
Rheumatic Heart Disease Damage to heart valves and muscle due to rheumatic fever, caused by streptococcal bacteria
Congenital Heart Disease Malformation of heart structure, present at birth
Deep Vein Thrombosis and Pulmonary Embolism Blood clots in leg veins, which can become dislodged and travel to the heart and lungs

Some systematic reviews have established that a relationship exists between periodontitis and cardiovascular disease,44-46 while others refute this association.47 One proposed mechanism for this relationship is that periodontal pathogens may be associated with cardiovascular complications, such as increased lipid accumulation and platelet aggregation.30 For instance, P. gingivalis and S. sanguis can increase platelet aggregation and gather to form arterial plaque. Atherosclerosis is a progressive disease marked by fibrous elements and lipids accumulating in the large arteries.40 Interestingly, A. actinomycetemcomitans has been located within atherosclerotic plaque.30 Other oral microbiota, such as Streptococcus, P. gingivalis, F. nucleatum, T. forsythia, and Neisseria, have also been detected in athersoclerotic plaque.39

It is likely that the pathogens enter the circulatory system via the oral mucosa and move to the arteries where LPS are secreted along with inflammatory mediators that result in atherothrombogensis.30 This supports the infection hypothesis of cardiovascular disease, where bacteria invade the bloodstream, enter the endothelium and cause endothelial dysfunction, inflammation and atherosclerosis.29 Periodontal patients who suffer from cardiovascular disease should be made aware of the potential risk factors associated between the two conditions. However, caution should be used during such discussions as no causal relationship has yet been established.