IJCS | Volume 32, Nº1, January/ February 2019

39 1. Andrade JP, Mattos LAP, Carvalho AC, Machado CA, Oliveira GMM. Programa nacional de qualificação de médicos na prevenção e atenção integral às doenças cardiovasculares. Arq Bras Cardiol. 2013;100(3):203-11. 2. Ramos MMB, Mendonça MR, Pelizzer EP, Okamoto AC, Jardim Jr EG. Associação entre a doença periodontal e doenças sistêmicas crônicas: revisão de literatura. Arch Health Invest.2013;2(1):24-31. 3. Hussain M, Stover CM, Dupont A P. Gingivalis in periodontal disease and atherosclerosis – scenes of action for antimicrobial peptides and complement. Front Immunol. 2015; 6:45. 4. Saldanha KFD, Costa DC, Mazocato DC. Periodontal disease and cardiovascular diseases: review of literature. Arch Health Invest. 2015;4(1):31-6. References Moras et al. Impact of periodontal disease and coronary disease Int J Cardiovasc Sci. 2019;32(1)35-40 Original Article (ACS) after long-term follow-up of patients (10 years), demonstrates that the presence of active periodontal disease or its sequel (edentulous patients) has a significant impact on late mortality over 10 years. The most promising hypothesis to explain this association may lie in the analysis of inflammatory markers characteristic or predictive of cardiac ischemic events. 10 The inflamed and ulcerated periodontal pocket tissue acts as a route of entry for pathogens in the bloodstream, where it promotes bacteremia with dissemination throughout the host body. This pathway of infection is called transient metastatic bacteremia. The bacteremia caused by periodontal patogens interacts with the antibodies of the host and forms complexes that induce inflammatory reactions, a mechanism known as immunological metastatic lesion, responsible for the destructive process with the activation of defense cells, including macrophages and their precursors, monocytes, lymphocytes and polymorphonuclear leukocytes (PMNs). 11,12 Monocytes respond to the bacterial endotoxin (LPS) with the liberation of inflammatory mediators, such as prostaglandin E2, and certain cytokines, including interleukin-1b and tumor necrosis factor-alpha (TNF- α ). 13 These mediators promote vasodilation, increased vascular permeability, recruitment of inflammatory cells, connective tissue degradation and bone destruction. 14 Data obtained in the extensive American study NHANES, with 32.000 participants, showed that the relative risk for CVD increased by 25% among patients with periodontitis. In addition to the pathophysiological process previously presented, it is worth mentioning that there is an indirect relation between periodontal and cardiovascular diseases. 15 Patients with poor hygiene habits present low consumption of low- GI foods, such as fruits and vegetables, which can result in obesity, hypertension and diabetes mellitus (precursors of CVD). 13 The statistically significant association between obstructive coronary disease and presence of periodontal disease strongly suggests that the latter should be inlcuded among the risk factors for the development of obstructive coronary disease and atherosclerotic plaque instability, culminating in an acute coronary syndrome. 9 Conclusion A significant increase was noted in the long-term mortality (10 years) according with the progression of periodontal disease, which justifies its classification as a major risk factor for the development of cardiovascular diseases, as well as the need for prevention and treatment of oral diseases. Author contributions Conception and design of the research: Godoy MF. Acquisition of data: Moras LL, Accarini R. Analysis and interpretation of the data: Carvalho TA. Statistical analysis: GodoyMF. Writing of the manuscript: Oliveira MB. Critical revision of the manuscript for intellectual content: Ricci GA. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associated with any thesis or dissertation work. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors.