New endothelial markers: implications for coronary artery disease and chronic periodontitis

Type of funding sources: None.

There is an association between chronic periodontitis (CP) and coronary artery disease (CAD). Endothelial function is increasingly used as an important outcome measure in cardiovascular diseases. But the data on early markers endothelial dysfunction in patients with CP is limited.

Aim. To determine whether there are differences in parameters of tissue endothelial markers in gingiva between patients with CP, CAD or CAD and concomitant CP.

We examined 30 patients with CAD, 75 patients with CP and 35 patients with CAD and concomitant CP and 25 healthy control. There were no differences between the groups of patients with CP, CAD and co-morbidity in age, gender, smoking and obesity. In marginal gingiva NO-synthase-like cells (NOs-cells) and marker of endothelial progenitor cells (CD34+ cells) by immunohistochemical and morphometric analyses were assessed. Endothelium-dependent vasodilation (EDV) of the brachial artery was evaluated.

Immunoreactivity to NOs and the CD34+ cells was found mainly in the vascular. In patients with average and severe CP significant decrease of expression of NOs–cells (6.2 ± 2.4% vs 7.9 ± 1.9%, p < 0.05) and of CD34+ -cells (6.3%±1.8 vs 8.9 ± 2.6%, p < 0.05) in gingiva was detected. There were no differences of endothelial immunohistochemical markers between the groups of patients with mild CP and healthy person. In patients with CAD also significant decrease of expression of NOs–cells (5.0 ± 2.1%) and of CD34+ -cells (4.9%±2.0%) in gingiva was found. The most significance changes of gingival expression of NOs–cells (4.3 ± 1.4%) and of CD34+ -cells (3.8%±1.7%) in patients with CAD and concomitant CP were observed.

In the control group EDV 15.4 ± 6.5%, in patients with mild CP 13.9 ± 6.5, in patients with average and severe CP 10,9 ± 5,1% (p = 0.02 between healthy person). There were associations between the decrease of EDV of the brachial artery with gingival expression of NOs–cells and of CD34+ -cells (Spearman"s R = 0.575 and R = 0.578).

Average and severe periodontitis is associated with vascular effects outside the oral cavity. Periodontitis also as CAD are associated with changes in the cell expression of NOs and endothelial progenitor cells in the periodontal tissue. Immunohistochemical assessment of endothelial markers in periodontium is a promising method of early assessment of endothelial dysfunction in cardiovascular disease.