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Role of Periodontal Bacteria and Importance of Total Pathogen Burden in the Coronary Event and Periodontal Disease (CORODONT) Study

Axel Spahr, DDS; Elena Klein, DDS; Natalie Khuseyinova, MD; Clemens Boeckh, PhD; Rainer Muche, PhD; Markus Kunze, MS; Dietrich Rothenbacher, MD, MPH; Gita Pezeshki, PhD; Albrecht Hoffmeister, MD; Wolfgang Koenig, MD

Arch Intern Med. 2006;166:554-559.

Background  Chronic inflammation from any source is associated with increased cardiovascular risk. Periodontitis is a possible trigger of chronic inflammation. We investigated the possible association between periodontitis and coronary heart disease (CHD), focusing on microbiological aspects.

Methods  A total of 789 subjects (263 patients with angiographically confirmed, stable CHD and 526 population-based, age- and sex-matched controls without a history of CHD) were included in the Coronary Event and Periodontal Disease (CORODONT) study. Subgingival biofilm samples were analyzed for periodontal pathogens Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola using DNA-DNA hybridization. The need for periodontal treatment in each subject was assessed using the Community Periodontal Index of Treatment Needs (CPITN). The main outcome measures included total periodontal pathogen burden, number of the various periodontal pathogens in the subgingival biofilm, and periodontal treatment needs (according to the CPITN).

Results  In multivariable analyses, we found a statistically significant association between the periodontal pathogen burden (log₁₀ of the sum of all pathogens) (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.34-2.74; P<.001) or the number of A actinomycetemcomitans in periodontal pockets (log₁₀) (OR, 2.70; 95% CI, 1.79-4.07; P<.001) and the presence of CHD. In addition, a statistically significant association between an increase in mean CPITN score by 1 and the presence of CHD (OR, 1.67; 95% CI, 1.08-2.58; P = .02) was observed.

Conclusions  Our findings suggest an association between periodontitis and presence of CHD. Periodontal pathogen burden, and particularly infection with A actinomycetemcomitans, may be of special importance.

Author Affiliations: Departments of Operative Dentistry and Periodontology (Drs Spahr, Klein, Boeckh, and Pezeshki), Internal Medicine II–Cardiology (Drs Khuseyinova, Hoffmeister, and Koenig and Mr Kunze), and Biometry and Medical Documentation (Dr Muche), University of Ulm Medical Center, Ulm, Germany; and Department of Epidemiology (Dr Rothenbacher), The German Center for Research on Aging, Heidelberg, Germany.

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