Periodontal Infections and Coronary Heart Disease: Role of Periodontal Bacteria and Importance of Total Pathogen Burden. The COROnary Event and PerioDONTal Disease (CORODONT) Study Conclusion In summary, we found a statistically significant association between periodontitis and the presence of CHD, even after controlling for a variety of potential confounders. Microbiological parameters, like total periodontal pathogen burden and especially the amount of Actinobacillus actinomycetemcomitans in the periodontal pockets seem to be of greater importance as potential risk factors for CHD than the clinical parameter CPITN. Material and Methods 263 Patients with clinically stable CAD aged years and 526 popu- lation-based, age and gender matched controls without history of CHD were recruited 263 Patients with clinically stable CAD aged years and 526 popu- lation-based, age and gender matched controls without history of CHD were recruited Participation rate was 71% in eligible patients and 67% in eligible control subjects Participation rate was 71% in eligible patients and 67% in eligible control subjects Subgingival biofilm samples were analyzed for the main periodontal pathogens, such as Actinobacillus actinomycetemcomitans (A. actino- mycetemcomitans), Tannerella forsythensis (T.forsythensis), Porphyro- monas gingivalis (P. gingivalis), Prevotella intermedia (P. intermedia) and Treponema denticola (T. denticola), using DNA-DNA hybridisation Subgingival biofilm samples were analyzed for the main periodontal pathogens, such as Actinobacillus actinomycetemcomitans (A. actino- mycetemcomitans), Tannerella forsythensis (T.forsythensis), Porphyro- monas gingivalis (P. gingivalis), Prevotella intermedia (P. intermedia) and Treponema denticola (T. denticola), using DNA-DNA hybridisation The need for periodontal treatment in each subject was assessed using the community periodontal index of treatment needs (CPITN) The need for periodontal treatment in each subject was assessed using the community periodontal index of treatment needs (CPITN) Measurements of the CPITN were performed at 6 sites of each tooth. The oral cavity of each patient was divided into sextants; for each sextant the highest index found was recorded according to the following score: 0 = periodontal health, 1 = gingival bleeding, 2 = calculus and/or overhanging restorations, 3 = pocket depth 4-5 mm, 4 = pocket depth  6 mm. Finally, the periodontal disease status of each subject was reported as the mean index score of all sextants. Additionally, the deepest pocket depth (ST-Max) as well as the number of missing teeth, and the number of toothless sextants were recorded in all subjects Measurements of the CPITN were performed at 6 sites of each tooth. The oral cavity of each patient was divided into sextants; for each sextant the highest index found was recorded according to the following score: 0 = periodontal health, 1 = gingival bleeding, 2 = calculus and/or overhanging restorations, 3 = pocket depth 4-5 mm, 4 = pocket depth  6 mm. Finally, the periodontal disease status of each subject was reported as the mean index score of all sextants. Additionally, the deepest pocket depth (ST-Max) as well as the number of missing teeth, and the number of toothless sextants were recorded in all subjects For all potential periodontal and microbiological risk factors, crude and adjusted odds ratios (OR) together with their 95% confidence intervals (CI) and the respective p-value were calculated by means of conditional logistic regression For all potential periodontal and microbiological risk factors, crude and adjusted odds ratios (OR) together with their 95% confidence intervals (CI) and the respective p-value were calculated by means of conditional logistic regression Association Between Periodontal Pathogens and CHD by Conditional Logistic Regression Analysis § Introduction Chronic inflammation from any source is associated with increased cardiovascular risk. Periodontitis is discussed as a possible trigger of chronic inflammation. The aim of the present study was to investigate the possible association between periodontal disease and coronary heart disease (CHD) focusing on microbiological aspects. Axel Spahr 1, Natalie Khuseyinova 2, Elena Klein 1, Clemens Boeckh 1, Rainer Muche 3, Dietrich Rothenbacher 4, Albrecht Hoffmeister 2, Wolfgang Koenig 2 1 Department of Operative Dentistry and Periodontology and 2 Department of Internal Medicine II- Cardiology, University of Ulm Medical Center; 3 Department of Biometry and Medical Documentation at the University of Ulm, Ulm, Germany; 4 Department of Epidemiology, German Centre for Research on Ageing at the University of Heidelberg, Heidelberg, Germany 16S rDNA/rRNA Directed Probes Species Sequence of probe (5‘ to 3‘) Length AC number of 16S rRNA sequence A. actinomycetemcomitans cac tta aag gtc cgc cta cgt gcc 24 M75035 P. gingivalis caa tac tcg tat cgc ccg tta 21 L16492 P. intermedia gtt gcg tgc act caa gtc cgc c 21 X73965 T. forsythensis cgt atc tca ttt tat tcc cct gta 24 L16495 T. denticola ggc tta ttc gca tga cta ccg t 22 M71236 Characteristics of the Study Population (n=789) CORODONT VariableCasesControlsUnadjusted Adjusted & MedianMedian OR (95% CI) P-Value P-Value Total periodontal pathogen burden* 79x x ( ) ( ) A.Actinomycetemcomitans * 30x10 3 8x ( )< ( ) ( )< P.gingivalis * 5x10 3 8x ( ) ( )0.10 T.forsythensis * 1x10 3 5x ( )< ( ) ( )0.79 P.intermedia * 10x ( ) ( )0.049 T.denticola * 1x10 3 5x ( )< ( ) ( )0.74 Characteristic Cases (n=263) Controls (n=526) Male (%) † 8787 Mean Age (years), (SD) † 61.0 (7.1) Mean BMI, (SD) 28.3 (3.5) 26.7 (3.7) Smoking status (%) Current Current1415 Past Past6045 Never Never2640 Alcohol consumption (%) Daily Daily3033 No alcohol No alcohol13 9 Occasionally Occasionally5758 History of myocardial infarction (%) 68 0 History of hypertension (%) 6036 History of hyperlipoproteinemia (%) 7835 History of diabetes (%) 14 6 School education < 10 years (%) 7144 Physical activity (%) ‡ 8467 Total cholesterol, mean (SD) (45.2) (34.1) Statin intake (%) 73 4 SD = Standard Deviation; BMI = Body Mass Index; † Matching variables; ‡ < 2hours/week § for an increase in periodontal pathogens of log (10); * log=amount of pathogens logarithmically transformed to the basis of 10; & adjusted for age, sex, body mass index, smoking, alcohol consumption, diabetes, hypertension, hyperlipoproteinemia, school education, physical activity, and statin intake ResultsVariableOR 95% CI P-Value CPITN § crude adjusted* ST-max § crude adjusted* *adjusted for age, gender, body mass index, smoking, alcohol consumption, diabetes, hypertension, hyperlipoteinemia, school education, physical activity, and statin intake § for an increase in mean CPITN of 1 unit and an increase in ST-max of 1 mm Association Between CPITN or ST-Max and CHD Variable OR (95% CI) P-Value Total periodontal pathogen burden (log) 1.83 (1.23 – 2.71) CPITN-Mean 1.15 (0.70 – 1.89) 0.58 A.actinomycetemcomitans (log) 2.68 (1.74 – 4.14) < CPITN-Mean 1.02 (0.62 – 1.70) 0.93 P.intermedia (log) 1.25 (0.85 – 1.84) 0.26 CPITN-Mean 1.48 (0.92 – 2.39) 0.10 Association Between Periodontal Pathogens, CPITN, and CHD Simultaneously Assessed in the Same Basic Model* for an increase in mean CPITN of 1 unit and an increase in periodontal pathogens of log (10); pathogen numbers were logarithmically transformed to the basis of 10; *adjusted for age, gender, BMI, smoking, alcohol consumption, diabetes, hypertension, hyperlipoproteinemia, school education, physical activity, and statin intake Variable Cases (n=263) Controls (n=526) CPITN Median (IQR) Median (IQR) 2.8 (2.3; 3.3) 2.8 (2.2; 3.3) Mean (SD) Mean (SD) 2.8 (0.8) 2.7 (0.9) ST-max (mm) Median (IQR) Median (IQR) 6.0 (5.0; 8.0) Mean (SD) Mean (SD) 6.4 (2.4) 6.3 (2.2) Complete tooth loss (%) 82 Partial tooth loss (%) 2719 Mean number of toothless sextants (SD) 1.3 (2.0) 0.6 (1.5) Peridontal Characteristics of the Study Population (n=789)