Top

Published in:

01-06-2021 | Original Article

The severity and extent of periodontitis is associated with cardio-ankle vascular index, a novel arterial stiffness parameter

Authors: Kansurang Chansawang, Attawood Lertpimonchai, Nisachon Siripaiboonpong, Lalitsara Thienpramuk, Prin Vathesatogkit, Thosaphol Limpijankit, Orawan Charatkulangkun

Published in: Clinical Oral Investigations | Issue 6/2021

Abstract

Objectives

To evaluate the association between the severity and extent of periodontitis and arterial stiffness using the cardio-ankle vascular index (CAVI).

Materials and methods

A cross-sectional study of 2888 Electricity Generation Authority of Thailand (EGAT) employees aged 44–78 years was conducted. The severity of periodontitis was evaluated based on mean clinical attachment level (CAL). The percentage of sites with CAL ≥ 5 mm was used to divide the extent of periodontitis into healthy (0%), localized (> 0–< 30%), and generalized (≥ 30%). The CAVI value, a novel blood pressure-independent arterial stiffness parameter, was analyzed as both continuous and categorical data (low: < 9 or high: ≥ 9). Regression analysis was used to estimate the level of association.

Results

The participants demonstrated a mean CAL, % sites with CAL ≥ 5 mm, and a CAVI value of 3.2 ± 1.2 mm, 16.0 ± 20.8%, and 8.24 ± 1.12, respectively. Higher mean CAVI was observed with greater mean CAL and % sites with CAL ≥ 5 mm. The mean CAVI of the healthy, localized, and generalized periodontitis groups were 8.01 ± 1.11, 8.22 ± 1.12, and 8.51 ± 1.04, respectively (p < 0.01). Linear and logistic regression analysis demonstrated a significant relationship between CAVI and all periodontal variables with β = 0.004–0.17 and OR = 1.01–1.58, respectively.

Conclusions

There is a significant dose-dependent association between the severity and extent of periodontitis and arterial stiffness measured by CAVI in Thai adults.

Clinical relevance

Preventing arterial stiffness, an early sign of cardiovascular events, by controlling the emerging risk factors, such as periodontitis, might have a high impact on health promotion.

Sanz M, Ceriello A, Buysschaert M, Chapple I, Demmer RT, Graziani F, Herrera D, Jepsen S, Lione L, Madianos P, Mathur M, Montanya E, Shapira L, Tonetti M, Vegh D (2018) Scientific evidence on the links between periodontal diseases and diabetes: consensus report and guidelines of the joint workshop on periodontal diseases and diabetes by the International diabetes Federation and the European Federation of Periodontology. Diabetes Res Clin Pract 137:231–241. https://doi.org/10.1016/j.diabres.2017.12.001CrossRefPubMed

Ide M, Papapanou PN (2013) Epidemiology of association between maternal periodontal disease and adverse pregnancy outcomes – systematic review. J Clin Periodontol 40:S181–S194. https://doi.org/10.1111/jcpe.12063CrossRefPubMed

Lertpimonchai A, Rattanasiri S, Tamsailom S, Champaiboon C, Ingsathit A, Kitiyakara C, Limpianunchai A, Attia J, Sritara P, Thakkinstian A (2019) Periodontitis as the risk factor of chronic kidney disease: mediation analysis. J Clin Periodontol 46:631–639. https://doi.org/10.1111/jcpe.13114CrossRefPubMedPubMedCentral

Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, Taubert KA, Newburger JW, Gornik HL, Gewitz MH, Wilson WR, Smith SC Jr, Baddour LM (2012) Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation 125:2520–2544. https://doi.org/10.1161/CIR.0b013e31825719f3CrossRefPubMed

Tonetti MS, Van Dyke TE (2013) Periodontitis and atherosclerotic cardiovascular disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J Periodontol 84:S24–S29. https://doi.org/10.1902/jop.2013.1340019CrossRefPubMed

van Popele NM, Grobbee DE, Bots ML, Asmar R, Topouchian J, Reneman RS, Hoeks AP, van der Kuip DA, Hofman A, Witteman JC (2001) Association between arterial stiffness and atherosclerosis: the Rotterdam Study. Stroke 32:454–460. https://doi.org/10.1161/01.str.32.2.454CrossRefPubMed

Houcken W, Teeuw WJ, Bizzarro S, Alvarez Rodriguez E, Mulders TA, van den Born BJ, Loos BG (2016) Arterial stiffness in periodontitis patients and controls. A case-control and pilot intervention study. J Hum Hypertens 30:24–29. https://doi.org/10.1038/jhh.2015.41CrossRefPubMed

Jockel-Schneider Y, Harks I, Haubitz I, Fickl S, Eigenthaler M, Schlagenhauf U, Baulmann J (2014) Arterial stiffness and pulse wave reflection are increased in patients suffering from severe periodontitis. PLoS One 9:e103449. https://doi.org/10.1371/journal.pone.0103449CrossRefPubMedPubMedCentral

Kapellas K, Jamieson LM, Do LG, Bartold PM, Wang H, Maple-Brown LJ, Sullivan D, O'Dea K, Brown A, Celermajer DS, Slade GD, Skilton MR (2014) Associations between periodontal disease and cardiovascular surrogate measures among Indigenous Australians. Int J Cardiol 173:190–196. https://doi.org/10.1016/j.ijcard.2014.02.015CrossRefPubMed

10.

Schmitt A, Carra MC, Boutouyrie P, Bouchard P (2015) Periodontitis and arterial stiffness: a systematic review and meta-analysis. J Clin Periodontol 42:977–987. https://doi.org/10.1111/jcpe.12467CrossRefPubMed

11.

Shanker J, Setty P, Arvind P, Nair J, Bhasker D, Balakrishna G, Kakkar VV (2013) Relationship between periodontal disease, Porphyromonas gingivalis, peripheral vascular resistance markers and coronary artery disease in Asian Indians. Thromb Res 132:e8–e14. https://doi.org/10.1016/j.thromres.2013.04.023CrossRefPubMed

12.

Hayashida H, Saito T, Kawasaki K, Kitamura M, Furugen R, Iwasaki T, Hayashida Y, Nakazato M, Sekita T, Takamura N, Maeda T (2013) Association of periodontitis with carotid artery intima-media thickness and arterial stiffness in community-dwelling people in Japan: the Nagasaki Islands study. Atherosclerosis 229:186–191. https://doi.org/10.1016/j.atherosclerosis.2013.04.002CrossRefPubMed

13.

Orlandi M, Suvan J, Petrie A, Donos N, Masi S, Hingorani A, Deanfield J, D'Aiuto F (2014) Association between periodontal disease and its treatment, flow-mediated dilatation and carotid intima-media thickness: a systematic review and meta-analysis. Atherosclerosis 236:39–46. https://doi.org/10.1016/j.atherosclerosis.2014.06.002CrossRefPubMed

14.

Holtfreter B, Empen K, Gläser S, Lorbeer R, Völzke H, Ewert R, Kocher T, Dörr M (2013) Periodontitis is associated with endothelial dysfunction in a general population: a cross-sectional study. PLoS One 8:e84603. https://doi.org/10.1371/journal.pone.0084603CrossRefPubMedPubMedCentral

15.

Tonetti MS, D'Aiuto F, Nibali L, Donald A, Storry C, Parkar M, Suvan J, Hingorani AD, Vallance P, Deanfield J (2007) Treatment of periodontitis and endothelial function. N Engl J Med 356:911–920. https://doi.org/10.1056/NEJMoa063186CrossRefPubMed

16.

Stoner L, Young JM, Fryer S (2012) Assessments of arterial stiffness and endothelial function using pulse wave analysis. Int J Vasc Med 2012:903107–903109. https://doi.org/10.1155/2012/903107CrossRefPubMedPubMedCentral

17.

Wilkinson IB, Cockcroft JR, Webb DJ (1998) Pulse wave analysis and arterial stiffness. J Cardiovasc Pharmacol 32(Suppl 3):S33–S37PubMed

18.

Horinaka S, Yabe A, Yagi H, Ishimura K, Hara H, Iemua T, Matsuoka H (2009) Comparison of atherosclerotic indicators between cardio ankle vascular index and brachial ankle pulse wave velocity. Angiology 60:468–476. https://doi.org/10.1177/0003319708325443CrossRefPubMed

19.

Shirai K, Utino J, Otsuka K, Takata M (2006) A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI). J Atheroscler Thromb 13:101–107. https://doi.org/10.5551/jat.13.101CrossRefPubMed

20.

Takaki A, Ogawa H, Wakeyama T, Iwami T, Kimura M, Hadano Y, Matsuda S, Miyazaki Y, Matsuda T, Hiratsuka A, Matsuzaki M (2007) Cardio-ankle vascular index is a new noninvasive parameter of arterial stiffness. Circ J 71:1710–1714. https://doi.org/10.1253/circj.71.1710CrossRefPubMed

21.

Fukuda-Denshi Company L,Tokyo, Japan. https://fukuda.com/products/vs-2000/. Accessed: 30 August, 2019.

22.

Kabutoya T, Kario K (2019) Comparative assessment of cutoffs for the cardio-ankle vascular index and brachial-ankle pulse wave velocity in a nationwide registry: a cardiovascular prognostic coupling study. Pulse (Basel) 6:131–136. https://doi.org/10.1159/000489604CrossRef

23.

Nakamura K, Tomaru T, Yamamura S, Miyashita Y, Shirai K, Noike H (2008) Cardio-ankle vascular index is a candidate predictor of coronary atherosclerosis. Circ J 72:598–604. https://doi.org/10.1253/circj.72.598CrossRefPubMed

24.

Takaki A, Ogawa H, Wakeyama T, Iwami T, Kimura M, Hadano Y, Matsuda S, Miyazaki Y, Hiratsuka A, Matsuzaki M (2008) Cardio-ankle vascular index is superior to brachial-ankle pulse wave velocity as an index of arterial stiffness. Hypertens Res 31:1347–1355. https://doi.org/10.1291/hypres.31.1347CrossRefPubMed

25.

Shirai K, Hiruta N, Song M, Kurosu T, Suzuki J, Tomaru T, Miyashita Y, Saiki A, Takahashi M, Suzuki K, Takata M (2011) Cardio-ankle vascular index (CAVI) as a novel indicator of arterial stiffness: theory, evidence and perspectives. J Atheroscler Thromb 18:924–938. https://doi.org/10.5551/jat.7716CrossRefPubMed

26.

Kadota K, Takamura N, Aoyagi K, Yamasaki H, Usa T, Nakazato M, Maeda T, Wada M, Nakashima K, Abe K, Takeshima F, Ozono Y (2008) Availability of cardio-ankle vascular index (CAVI) as a screening tool for atherosclerosis. Circ J 72:304–308. https://doi.org/10.1253/circj.72.304CrossRefPubMed

27.

Namba T, Masaki N, Takase B, Adachi T (2019) Arterial stiffness assessed by cardio-ankle vascular index. Int J Mol Sci 20. https://doi.org/10.3390/ijms20153664

28.

Laucevičius A, Ryliškytė L, Balsytė J, Badarienė J, Puronaitė R, Navickas R, Solovjova S (2015) Association of cardio-ankle vascular index with cardiovascular risk factors and cardiovascular events in metabolic syndrome patients. Medicina (Kaunas) 51:152–158. https://doi.org/10.1016/j.medici.2015.05.001CrossRef

29.

Yingchoncharoen T, Limpijankit T, Jongjirasiri S, Laothamatas J, Yamwong S, Sritara P (2012) Arterial stiffness contributes to coronary artery disease risk prediction beyond the traditional risk score (RAMA-EGAT score). Heart Asia 4:77–82. https://doi.org/10.1136/heartasia-2011-010079CrossRefPubMedPubMedCentral

30.

Elosua-Bayes M, Marti-Lluch R, Garcia-Gil MDM, Camos L, Comas-Cufi M, Blanch J, Ponjoan A, Alves-Cabratosa L, Elosua R, Grau M, Marrugat J, Ramos R (2018) Association of classic cardiovascular risk factors and lifestyles with the cardio-ankle vascular index in a general Mediterranean population. Rev Esp Cardiol (Engl Ed) 71:458–465. https://doi.org/10.1016/j.rec.2017.09.011CrossRef

31.

Chung SL, Yang CC, Chen CC, Hsu YC, Lei MH (2015) Coronary artery calcium score compared with cardio-ankle vascular index in the prediction of cardiovascular events in asymptomatic patients with type 2 diabetes. J Atheroscler Thromb 22:1255–1265. https://doi.org/10.5551/jat.29926CrossRefPubMed

32.

Carrizales-Sepulveda EF, Ordaz-Farias A, Vera-Pineda R, Flores-Ramirez R (2018) Periodontal disease, systemic inflammation and the risk of cardiovascular disease. Heart Lung Circ 27:1327–1334. https://doi.org/10.1016/j.hlc.2018.05.102CrossRefPubMed

33.

Teles R, Wang CY (2011) Mechanisms involved in the association between periodontal diseases and cardiovascular disease. Oral Dis 17:450–461. https://doi.org/10.1111/j.1601-0825.2010.01784.xCrossRefPubMedPubMedCentral

34.

Burt B (2005) Position paper: epidemiology of periodontal diseases. J Periodontol 76:1406–1419. https://doi.org/10.1902/jop.2005.76.8.1406CrossRefPubMed

35.

Lindhe J, Ranney R, Lamster I, Charles A, Chung C-P, Flemmig T, Kinane D, Listgarten M, Löe H, Schoor R, Seymour G, Somerman M. Consensus report: chronic periodontitis 1999;4:38-38. https://doi.org/10.1902/annals.1999.4.1.38.

36.

Asai K, Yamori M, Yamazaki T, Yamaguchi A, Takahashi K, Sekine A, Kosugi S, Matsuda F, Nakayama T, Bessho K (2015) Tooth loss and atherosclerosis: the Nagahama Study. J Dent Res 94:52s–58s. https://doi.org/10.1177/0022034514559127CrossRefPubMedPubMedCentral

37.

D'Agostino RB Sr, Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, Kannel WB (2008) General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 117:743–753. https://doi.org/10.1161/circulationaha.107.699579CrossRefPubMed

Title: The severity and extent of periodontitis is associated with cardio-ankle vascular index, a novel arterial stiffness parameter
Authors: Kansurang Chansawang
Attawood Lertpimonchai
Nisachon Siripaiboonpong
Lalitsara Thienpramuk
Prin Vathesatogkit
Thosaphol Limpijankit
Orawan Charatkulangkun
Publication date: 01-06-2021
Publisher: Springer Berlin Heidelberg
Published in: Clinical Oral Investigations / Issue 6/2021
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-020-03670-1

At a glance: The STEP trials

Springer Medicine

The severity and extent of periodontitis is associated with cardio-ankle vascular index, a novel arterial stiffness parameter

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Please log in to get access to this content

Other articles of this Issue 6/2021

Do bleaching gels affect the stability of the masking and caries-arresting effects of caries infiltration—in vitro

Is alteration in single drug anticoagulant/antiplatelet regimen necessary in patients who need minor oral surgery? A systematic review with meta-analysis

Assessment of oral health in older adults by non-dental professional caregivers—development and validation of a photograph-supported oral health–related section for the interRAI suite of instruments

Periodontal manifestations of Langerhans cell histiocytosis: a systematic review

Correction to: Diagnostic accuracy of clinical visualization and light-based tests in precancerous and cancerous lesions of the oral cavity and oropharynx: a systematic review and meta-analysis

Tailored 70S30C Bioactive glass induces severe inflammation as pulpotomy agent in primary teeth: an interim analysis of a randomised controlled trial