IJCS | Volume 32, Nº1, January/ February 2019

36 Moras et al. Impact of periodontal disease and coronary disease Int J Cardiovasc Sci. 2019;32(1)35-40 Original Article The groups of PD include periodontitis, whose main causal agent is the bacterial plaque, which causes a chronic inflammatory process that affects the tissues of tooth support, including the periodontal ligament and alveolar bone. 3 It is worthy of note that both diseases share common risk factors, including obesity, smoking, diabetes mellitus and low educational level. 4 PD bacteria can disseminate hematogenously during dental procedures or as a result of inflammatory processes and dental loss in patients with low oral health. 5 The proximity of the oral biofilm to the periodontal vasculature facilitates the spread of bacteria to different histological sites 6 promoting changes in the lungs, kidneys and in the cardiovascular system. In general, the presence of lipopolysaccharide (LPS) from anaerobic gram-negative bacteria, associated with the release of pro-inflammatory cytokines (IL-1, IL-6, TNF- α and prostaglandin E2), increased fibrinogen levels and C-reactive protein (CRP), promotes the activation of polymorphonuclear and macrophages with immunological response in the intima layer, which speeds the formation of foam cells, basic structures of the atherosclerotic plaque. 7 Furthermore, LPS can promote lipogenesis through direct action on the hepatocytes, also intensifying the formation of atheroma plaques. 8 The aimof this study is to demonstrate and understand the relations established between PD andCVD in patients with acute coronary syndrome and proven diagnosis of PD, in terms of morbimortality, and who were followed during 10 years. Methods The research was designed as a historical prospective study of continuous evaluation of 361 patient medical files assessed for the first time around 10 years ago in Accarini’s study, 20069. The access to the files was granted andmonitored by the Research Ethics Committee (CAAE 44588915.9.0000.5415). After the 10-year period, out of the 361 initial medical files, 345 (95,6%) were found for the current assessment. The lack of 16 medical files may be a result of the computerization process of the hospital management system, with a possible loss during the replacement of the paper medical records by the electronic medical records in the hospital. The assessment and classification of the patients in 2006, in relation to periodontal disease, were performed by one single odontologist, specialized in periodontics, through clinical analysis carried out in the doctor’s office or in hospital (patients in ICU). All six surfaces of the teeth were inspected, with assessment of the following parameters: level of pocket depth, level of clinical insertion, gingival index and plaque index. Out of the 345 medical files assessed, it was possible to keep the classification in relation to the PD: edentulous (182), with periodontal disease (113) and without periodontal disease (50). In relation to CVD, in 2006, the diagnosis of unstable angina or acute myocardial infarction was established according to clinical, electrocardiographic and enzymatic criteria and coronary cineangiography. Therefore, the 345 patients were classified in relation to the CVDs into: without coronary disease (66), at least one coronary obstruction, always < 50% (12), at least one coronary obstruction, ≥ 50% (233) and those who did not undergo catheterization (34). Statistical analysis The qualitative variables were compared using the Chi-square test. Long-term mortality was assessed using the Kaplan-Meier curves, quantified with the hazard ratio (HR) and a confidence interval of 95% and compared through Cox regression. P values of less than or equal to 0.05 were regarded as statistically significant. Results Table 1 was structured based on the evaluation of the 345 medical records found, showing the number of patients according to the circumstances studied, both periodontal and cardiovascular, after ten-year evolution from the first analysis. 9 Edentulous patients with at least one coronary obstruction ≥ 50% (Group A) were analyzed, with 125 elements in this intersection, and compared with the patients with no periodontal disease and no coronary disease (Group B), with 16 elements. During the 10-year- period of follow-up, the total death numbers observed in groups A and B were, respectively, 43 and 1. The Hazard Ratio for Group A versus Group B was equal to 6.853 (95%CI: 2.905-16.164). The chi-square test for equivalence of mortality rates indicated a p value of 0.0305. Thus, Chart 1 shows a comparison of patient survival in groups A and B during the follow-up period. Another chart (Chart 2) was organized to compare Group A, with 125 elements, with the group of patients