Link Between Interstitial Myocardial Fibrosis and Periodontal Disease Greater in Men

While previous research suggests that the presence and severity of periodontal disease may augment the risk of developing cardiovascular disease (CVD), the exact mechanisms for the heightened risks are not fully understood and warrant more research.

In a recent publication in the Journal of the American Heart Association, Maria Doughan, DDS, MSc, Division of Orthodontics, Department of Dentistry, University of Maryland, Baltimore, MD, and colleagues attempted to utilize data from the MESA (Multiethnic Study of Atherosclerosis) population to evaluate the association between self‐reported periodontal disease (PD) at Visit 1 and incidence of interstitial myocardial fibrosis (IMF) at Exam 5, 10 years later.

MESA is a multicenter, community‐based, prospective study that enrolled 6,814 men and women from various racial and ethnic groups.

This study involved a total of 1,276 participants for MESA which included 665 men (52.1%) with an average age of 68±9 years. Among the men, the study population included: 51% non‐Hispanic Caucasian,23% African American, 15% Hispanic, and 11% Asian individuals. The other half of the study participants included 611 women (47.9%) with an average age of 67±9 years who were enrolled in MESA. Among the women, the study population included : 54% Caucasian, 23% African American, 12% Hispanic and 10% Asian.

The participants were administered an evaluation with regard to periodontal disease utilizing a 2‐item questionnaire at baseline (2000–2002) and had cardiovascular magnetic resonance a decade later. The two questions included: (1) if there was a history of periodontal disease and (2) if tooth loss occurred due to periodontal disease.    

The researchers indicated that they employed multivariable linear regression models to examine the correlations between patient-reported periodontal disease at baseline with cardiovascular magnetic resonance (CMR)–obtained measures of IMF which also involved measurement of extracellular volume and native T1 time.

Results indicated that more men in the study were smokers when compared to the women, the number of men with diabetes was also higher, but both genders had comparable impaired fasting blood glucose values accounting for 26% of participants.  Additionally, compared to women, men also had higher values for diastolic blood pressure, lower HDL and LDL levels.

Cardiac MRI scores also contrasted between the genders. The authors wrote, “ Men had greater left ventricular end‐systolic and diastolic volumes, left ventricular mass, and myocardial scar prevalence than women. However, they showed lower left ventricular ejection fraction, and on T1 mapping had less extracellular volume (ECV%) and native T1 than women (P<0.001).”

The authors also indicated that they discovered a significant correlation between the baseline evaluation of periodontal disease and CMR measures for IMF in the male participants. The researchers did not find a correlation of higher IMF and self-reported periodontal disease among women.

The authors indicated that the correlation between interstitial myocardial fibrosis and periodontal disease could possibly be facilitated via elevated levels of systemic inflammation due to smoking, diabetes, obesity, and hypertension.

“To our knowledge, this study is the first multiethnic, multicenter population‐based study to describe the association between PD and IMF estimated by T1 mapping. Self‐reported PD was associated with greater IMF measures (ECV %) in men but not in women.”, wrote the authors. 

“In conclusion, the authors wrote, “ In a community‐based setting, using CMR measurements of IMF, men with a self‐reported PD history at baseline were found to have greater ECV after 10 years of follow‐up. This association was independent of age, traditional CVD risk factors, interim cardiovascular events, coronary artery calcium score, and socioeconomic status. These findings support the plausible link between PD, a proinflammatory condition, and subclinical IMF.”

Reference

Doughan M, Chehab O, de Vasconcellos HD, Zeitoun R, Varadarajan V, Doughan B, Wu CO, Blaha MJ, Bluemke DA, Lima JAC. Periodontal Disease Associated With Interstitial Myocardial Fibrosis: The Multiethnic Study of Atherosclerosis. J Am Heart Assoc. 2023 Feb 7;12(3):e8146. doi: 10.1161/JAHA.122.027974. Epub 2023 Jan 31. PMID: 36718872; PMCID: PMC9973639.