Periodontitis Is Associated with Endothelial Dysfunction in a General Population: A Cross-Sectional Study
Open accessAbstract
A large body of evidence underlines an association between periodontal disease and cardiovascular disease. In contrast, data on its relation with endothelial dysfunction as a marker of early subclinical atherosclerosis is inconclusive and limited to patient-cohort studies. We therefore investigated the association between periodontal disease and flow-mediated dilation of the brachial artery (FMD) as a measure of endothelial dysfunction in a general population, and also addressed a possible mediation via inflammation. The study population comprised 1,234 subjects (50.5% men) aged 25-85 years from the 5-year follow-up of the Study of Health in Pomerania, a population-based cohort study. Clinical attachment loss (CAL) and pocket probing depth (PPD) as measures of periodontal disease were assessed half-mouth at four sites per tooth. Subjects were classified according to the periodontitis case definition proposed by Tonetti and Claffey (2005). Measurements of FMD and nitroglycerin-mediated dilation (NMD) were performed using standardized ultrasound techniques. High-sensitive C-reactive protein, fibrinogen and leukocyte count were measured. Fully adjusted multivariate linear regression analyses revealed significant associations of the percentage of sites with PPD ≥ 6 mm with FMD (p(trend)=0.048), with subjects within the highest category having a 0.74% higher FMD compared to subjects within the lowest category (p<0.05). Consistently, FMD values increased significantly across categories of the percentage of sites with CAL ≥ 6 mm (p(trend)=0.01) and the periodontitis case definition (p(trend)=0.006). Restrictions to subjects without antihypertensive or statin medication or current non-smokers confirmed previous results. Systemic inflammation did not seem to mediate the relation. Both PPD and CAL were not consistently associated with NMD. In contrast to previous studies, high levels of periodontal disease were significantly associated with high FMD values. This association was not mediated via systemic inflammation. This study revives the discussion on whether and how periodontitis contributes to endothelial dysfunction.
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Individuals with periodontitis have a higher prevalence of subclinical CVD, characterized by significant arterial stiffness and endothelial dysfunction.
“Additionally, there is evidence from various studies that individuals with periodontitis have a higher prevalence of subclinical CVD, which is characterized by significant arterial stiffness (assessed by pulse wave velocity [PWV]) [20] and endothelial dysfunction [21].”
From Effect of non-surgical periodontal therapy on risk markers of cardiovascular disease: a systematic review and meta-analysis (2024) · cites this paper as [21]
The citation to this paper is attached to the endothelial-dysfunction part of the sentence, not the PWV finding. Although the Introduction describes earlier studies reporting impaired endothelial function in patients with periodontitis, this paper’s Results and Discussion report the opposite direction in its general-population sample: more severe periodontal disease was associated with higher flow-mediated dilation, a measure of endothelial function. No page numbers are provided in our copy. (LLM, conf=0.88)
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Impact of calorie restriction and intermittent fasting on periodontal health
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Oral health of individuals with dementia and Alzheimer's disease: A review
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Impact of Matrix Metalloproteinase-9 during Periodontitis and Cardiovascular Diseases
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Implication of thyroid function in periodontitis: a nationwide population-based study
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Systemic inflammatory impact of periodontitis on acute coronary syndrome
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Local delivery of nitric oxide prevents endothelial dysfunction in periodontitis
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Periodontitis induces endothelial dysfunction in mice
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“Additionally, there is evidence from various studies that individuals with periodontitis have a higher prevalence of subclinical CVD, which is characterized by significant arterial stiffness (assessed by pulse wave velocity [PWV]) [20] and endothelial dysfunction [21].”
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Self-citationInterrelation of cardiovascular diseases with anaerobic bacteria of subgingival biofilm
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Vascular Endothelial Function in Periodontal Disease: Role of Inflammation
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Periodontal treatment modulates gene expression of endothelial progenitor cells in diabetic patients
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Periodontitis and multiple markers of cardiometabolic risk in the fourth decade: A cohort study
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Salivary Microbiota Associated with Peripheral Microvascular Endothelial Dysfunction
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Periodontitis as a risk factor for cardiovascular disease development: systematic review
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Oral microbiota in cardiovascular health and disease
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Individualized Medicine Within the GANI_MED Project
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- Authors
- Holtfreter, B., Empen, K., Gläser, S., Lorbeer, R., Völzke, H., Ewert, R., Kocher, T., & Dörr, M.
- Affiliations
- Universitätsmedizin Greifswald (DE)
- Corresponding author
- Holtfreter, Birte
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-12-26
- Volume
- 8
- Issue
- 12
- Pages
- e84603
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3873439
- OpenAlex
- W1992564668
- Cited by
- 79
- References
- 68
- Citations by year
- 2026: 7 · 2025: 4 · 2024: 7 · 2023: 5 · 2022: 6 · 2021: 11 · 2020: 4 · 2019: 6 · 2018: 6 · 2017: 5 · 2016: 4 · 2015: 8 · 2014: 6
- FWCI
- 7.27
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Deutsches Zentrum für Herz-Kreislaufforschung (01ZZ0701)
- Bundesministerium für Bildung und Forschung (03IS2061A, FKZ 01GI0881, 01ZZ0701, 01ZZ0403, 01GI0881, 01ZZ9603, 01ZZ0103, 01ZZ0403, 01ZZ9603, 01ZZ0103, 01ZZ0403, 01ZZ0701, FKZ 01GI0881-0888, 01ZZ0103, 01ZZ9603)
- Universität Greifswald
- Ministry of Cultural Affairs
- Topics
- Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Keywords
- periodontitis, endothelial dysfunction, flow-mediated dilation, nitroglycerin-mediated dilation, subclinical atherosclerosis, systemic inflammation, clinical attachment loss, probing depth, C-reactive protein, fibrinogen, white blood cell count, cardiovascular risk, general population
- MeSH terms
- Adult, Aged, Aged, 80 and over, Brachial Artery, Cardiovascular Diseases, Cross-Sectional Studies, Endothelium, Vascular, Female, Follow-Up Studies, Humans, Inflammation, Male, Middle Aged, Periodontitis
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