Thomas Pettersson

Periodontitis : a future risk of acute coronary syndrome?: A follow-up study over 3 years

BACKGROUNDnPeriodontitis has been associated with cardiovascular disease. We assess if the recurrence of acute coronary syndrome (ACS) could be predicted by preceding medical and periodontal conditions.nnnMETHODSnA total of 165 consecutive subjects with ACS and 159 medically healthy, matched control subjects were examined and followed for 3 years. Periodontitis was defined by alveolar bone loss. Subgingival microbial samples were studied by the checkerboard DNA-DNA hybridization method.nnnRESULTSnThe recurrence of ACS was found in 66 of 165 (40.0%) subjects, and a first ACS event was found in seven of 159 (4.4%) subjects among baseline control subjects. Subjects who later had a second ACS event were older (P <0.001). Significantly higher serum levels of high-density lipoprotein (P <0.05), creatinine (P <0.01), and white blood cell (WBC) counts (P <0.001) were found in subjects with future ACS. Periodontitis was associated with a first event of ACS (crude odds ratio [OR]: 10.3:1; 95% confidence interval [CI]: 6.1 to 17.4; P <0.001) and the recurrence of ACS (crude OR: 3.6:1; 95% CI: 2.0 to 6.6; P <0.001). General linear modeling multivariate analysis, controlling for age and the prediction of a future ACS event, identified that WBC counts (F = 20.6; P <0.001), periodontitis (F = 17.6; P <0.001), and serum creatinine counts (F = 4.5; P <0.05) were explanatory of a future ACS event.nnnCONCLUSIONSnThe results of this study indicate that recurrent ACS events are predicted by serum WBC counts, serum creatinine levels, and a diagnosis of periodontitis. Significantly higher counts of putative pathogens are found in subjects with ACS, but these counts do not predict future ACS events.

One year follow-up of patients with refractory angina pectoris treated with enhanced external counterpulsation

BackgroundEnhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to be effective in reducing both angina and myocardial ischemia in patients not responding to medical therapy and without revascularization alternatives. The aim of the present study was to assess the long-term outcome of EECP treatment at a Scandinavian centre, in relieving angina in patients with chronic refractory angina pectoris.Methods55 patients were treated with EECP. Canadian cardiovascular society (CCS) class, antianginal medication and adverse clinical events were collected prior to EECP, at the end of the treatment, and at six and 12 months after EECP treatment. Clinical signs and symptoms were recorded.ResultsEECP treatment significantly improved the CCS class in 79 ± 6% of the patients with chronic angina pectoris (p < 0.001). The reduction in CCS angina class was seen in patients with CCS class III and IV and persisted 12 months after EECP treatment. There was no significant relief in angina in patients with CCS class II prior to EECP treatment. 73 ± 7% of the patients with a reduction in CCS class after EECP treatment improved one CCS class, and 22 ± 7% of the patients improved two CCS classes. The improvement of two CCS classes could progress over a six months period and tended to be more prominent in patients with CCS class IV. In accordance with the reduction in CCS classes there was a significant decrease in the weekly nitroglycerin usage (p < 0.05).ConclusionThe results from the present study show that EECP is a safe treatment for highly symptomatic patients with refractory angina. The beneficial effects were sustained during a 12-months follow-up period.

Enhanced external counter pulsation in treatment of refractory angina pectoris: two year outcome and baseline factors associated with treatment failure.

BackgroundEnhanced external counter pulsation (EECP) is a non-invasive treatment option for patients with refractory angina pectoris ineligible to further traditional treatment. The aim of this study was to evaluate the effect of EECP on patients at a Scandinavian medical centre and to investigate if outcome can be predicted by analysing baseline factors.Methods86 consecutive patients (70 male, 16 female) were treated with EECP and followed for two years post treatment. Canadian cardiovascular society (CCS) class was analysed, and medication and adverse clinical events were researched prior to EECP, at the end of the treatment, and at six, 12 and 24 months thereafter. Patients responding to therapy by improving at least one CCS class were compared with those who failed to respond. Any differences in background factors were recorded and analysed.Results79% of the patients responded to therapy by improving at least one CCS class. In general, the CCS class improved by one class after EECP treatment (3.05 before versus 2.14 after treatment). A total of 61.5% of the initial responders showed sustained improvement at the 12 month follow-up while 29% presented sustained improvement after 24 months. Treatment was most effective among patients suffering from CCS class III-IV angina pectoris, while patients suffering from CCS class II angina pectoris improved transiently but failed to show sustained improvement after the 12 month follow-up. Diabetes mellitus and calcium channel antagonists were more common among the non-responders (p < 0.05).ConclusionThis study confirms the safety and efficiency of EECP as a treatment option for patients suffering from refractory angina pectoris. The therapy is most beneficial in patients suffering from severe angina (CCS III-IV) while sustained response to therapy could not be verified among patients suffering from CCS class II angina pectoris.

Comparison of patients undergoing enhanced external counterpulsation and spinal cord stimulation for refractory angina pectoris.

IntroductionAs more patients survive coronary events, the prevalence of patients with refractory angina pectoris is increasing. The aim was to evaluate the effects of enhanced external counterpulsation (EECP) and spinal cord stimulation (SCS) and compare with optimal medically treated patients with refractory angina. Methods153 patients with refractory angina were treated with either EECP, SCS, or were retained on their pharmacological treatment (control). Glyceryl trinitrate usage and Canadian Cardiovascular Society classification were registered at baseline, 6 and 12 months after therapy. ResultsBoth EECP and SCS reduced the angina as compared with controls (P<0.001). Patients treated with EECP showed a more effective reduction as compared with SCS patients (P<0.05). Both treatments resulted in significantly decreased glyceryl trinitrate usage at 6 and 12 months follow-up (P<0.001). The nitrate consumed was unaltered in the controls. DiscussionThe results from this study show that both EECP and SCS therapy reduce angina in patients with refractory angina pectoris; the response to EECP was slightly more effective than that to SCS. Thus, EECP can be used as an alternative treatment for patients not responding to electrical stimulation. The beneficial effects in the treated groups were maintained during the 12 months follow-up period.

Reduced peripheral vascular reactivity in refractory angina pectoris: Effect of enhanced external counterpulsation

Aims To examine if the skin microvascular bed is altered and can be modified by enhanced external counterpulsation (EECP) in patients with chronic refractory angina. Methods Twenty patients diagnosed with refractory angina were divided into EECP (n = 10) or no EECP (n = 10) groups. The data were compared to matched healthy subjects (n = 20). The cutaneous forearm microvascular blood flow was measured by Laser-Doppler flowmetry. The vascular responsiveness to iontophoretic administration of acetylcholine (ACh), sodium nitroprusside (SNP) and local skin warming were studied. Measurements of Canadian Cardiovascular Society (CCS)-class, blood pressure and plasma samples were registered. Results EECP patients showed reduced CCS-class compared to no EECP (P < 0.05). Both EECP and no EECP (P < 0.05) groups had decreased systolic blood pressure (SBP) as compared to SBP at baseline (P < 0.05). There was no difference in resting blood flow between the two refractory groups at baseline as well as after EECP and seven weeks of follow-up. Responses to heating, the responses to ACh and SNP in the cutaneous microcirculation were lower in both groups of refractory angina patients as compared to healthy subjects (P < 0.05). EECP patients corresponded positively to the treatment shown by reduced plasma level of soluble interleukin-2 receptor and CCS-class. Conclusions Refractory angina patients have reduced responsiveness in their cutaneous microcirculation to ACh, SNP and heat compared to healthy subjects. Although EECP reduced the CCS-class, this effect was not associated with improvements in responsiveness of the cutaneous microcirculation.

Effects on blood pressure in patients with refractory angina pectoris after enhanced external counterpulsation

Abstract Objective. Enhanced external counterpulsation (EECP) is a non-invasive technique that has been shown to reduce the frequency and severity of angina pectoris. Little is known how EECP affects the blood pressure. Methods. 153 patients with refractory angina were treated with either EECP or retained on their pharmacological treatment (reference group). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial blood pressure (MAP) and heart rate were measured pre- and post-treatment and at 12 months follow-up. Results. EECP treatment altered the blood pressure in patients with refractory angina pectoris. A decrease in the blood pressure was more common in the EECP group compared with the reference group. In the reference group, an increase in the blood pressure was more common. A correlation between a decrease in blood pressure after EECP treatment and a higher baseline MAP, SBP and DBP was seen. No such correlation was seen in the reference group. The blood pressure response did not persist at 12 months follow-up. Conclusion. EECP treatment affects the blood pressure in patients with refractory angina pectoris. The decreased blood pressure may be a result of an improved exercise capacity, an improved endothelial function and vasoreactivity in general.

Periodontitis a future risk for acute coronary syndrome? : a follow up study over 3 years

Background: Infection and inflammation in tissues adjacent to dental implants are common. There are few controlled studies assessing interventions. We assessed if mechanical debridement with titanium curettes, is equally effective as an ultrasonic device in reducing clinical signs of inflammation and the total bacterial load. Materials and methods: Thrity two subjects (mean age 62.5 S.D ± 11.7) with one implant each demonstrating peri-implantitis were randomized in two intervention groups. Clinical and microbiological data were obtained before and during 6 months. Group one received debridement using titanium hand-instruments and group two received ultrasonic treatment using a coated working end. Results: At the different time-points, data analysis by independent t–test, or Mann–Whitney U tests failed to demonstrate group differences. Comparing baseline data with results at 6 months (merged groups) demonstrated that overall PI scores and at implants decreased (mean diff: 20.2%, S.E ± 6.3, 95%CI: 7.0 to 32.7, P < 0.002) and (mean diff: 27.2% S.E ± 7.9, 95%CI: 11.3 to 43.1, P < 0.001). Bleeding scores at implants improved (P < 0.01). PPD scores at implants did not improve (P = 0.30). Conclusions: No differences in treatment outcomes between the two treatment methods studied were found. While PI and BOP scores improved no effects in PPD were identified.Aims: To assess whether recurrence of acute coronary syndrome (ACS) can be linked to periodontitis in subjects followed over a 3 year period. Methods and results: Consecutive 163 hospital admitted subjects with ACS, and 158 medically healthy matched control subjects were followed through medical records review over 3 years. At baseline, subjects received medical and dental examinations. Periodontitis was defined as alveolar bone loss (ABL) > 2 S.D. above normal mean values. Subgingival bacterial samples were collected and processed by checkerboard DNA–DNA hybridization. ACS recurrence was found in 66/163 (40.5%) subjects, and a first ACS event in 7/158 (4.4%) control subjects. ABL was a risk marker of future ACS with OR: 3.6 (95%CI: 2.0-6.5, P < 0.001). Subject age was also an explanatory factor for a new ACS event (P < 0.001). Significantly higher subgingival bacterial counts for 20/37 species (i.e., Streptococcus anginosus, Streptococcus mitis, Tannerella forsythia) in ACS cases than in healthy controls. None of traditional serum markers (CRP, high and low density lipoprotein, cholesterol, triglycerides) were explanatory. Conclusions: Age, and periodontitis (ABL) are robust markers of risk for future ACS. Subgingival bacterial counts are elevated in subjects with ACS.Background: Periodontal disease affect a large proportion of the adult population and cause an increasein serum levels of C- reactive protein (CRP), and other markers of inflammation. An increased level of CRP reflects an increased risk of cardiovascular disease. The aim of the current randomized clinical trial was to evaluate the short term effect of CRx-102 alone on the levels of hs-CRP, pro-inflammatory markers in blood and clinical signs of periodontal disease. Methods: Fifty seven patients with at least 10 pockets, with a probing depth of 5 mm or more, were randomized into two groups either CRx-102 (n = 28) or placebo (n = 29) in this blinded single-centre placebo controlled study. High sensitivity CRP (Hs-CRP) levels, inflammatory markers (IL-6, Il-1b, TNFa, IL12, IL-8, IFN c), bleeding on probing (BOP) and change in probing depths were evaluated. After 42 days the subjects received mechanical non-surgical therapy and the study was completed after 49 days. Results: At day 42 the difference in hs-CRP and IFN c levels between the two groups was statistically significant (P = 0.02 and P = 0.03, respectively) whereas no difference was found for the other inflammatory markers. There was no change in periodontal probing depth or BOP between the two groups. Conclusion: The current study demonstrated that the administration of CRx-102, resulted in significant decreases in hs- CRP and IFN c, but did not significantly change BOP or probing depths. 10:15–10:30 Ref no: EUABS065318 Anti TNF-a therapy and periodontal parameters in rheumatoid arthritis patients Y. MAYER*, A. GURMAN-BALBIR AND E. E. MACHTEI Unit of Periodontology, Rambam HCC, Haifa, Israel Aim: To evaluate the influence of anti TNF-a therapy on the clinical and immunological parameters of the periodontium. Materials and methods: Ten patients with RA who received infusion of 200 mg infliximab routinely (RA+), 10 patients with RA without anti TNF-a therapy (RA-) and 10 healthy patients (C) were included. Clinical parameters PI, GI, PD, CAL and BOP were assessed and total GCF TNF-a level was determined using ELISA. ANOVA with Fisher’s modification and Pearson correlation test were used for statistical analysis. Results: Patients’ age ranged between 22 and 76 years (mean 50.73 ± 9.1). Mean PI was similar between the groups. However, mean inflammatory parameters in the 3 groups varied significantly; GI was greater in the RA- compared with RA+ and C (P = 0.0042). RA+ exhibit less BOP than RA- and C (21.1% ± 3.0%, 45.9% ± 6.2% and 39.1% ± 7.2%; respectively, P = 0.0146) The mean PD in RA+ was shallower than RA- and C (3.22 ± 0.13, 3.85 ± 0.22, 3.77 ± 0.20; P = 0.055). CAL in RA+ was lower than RA- and C (3.68 ± 0.11, 4.52 ± 0.26, 4.35 ± 0.24; P = 0.0273). TNF-a levels in the GCF of RA+ were the lowest (0.663 pg/ml, 1.23 pg/ml and 0.949 pg/ml; P = 0.0401). A significant positive correlation was found between TNF-a levels in the GCF and CAL (r = 0.448, P = 0.0283). Conclusion: Rheumatoid arthritis patients receiving anti TNF-a medications have lower periodontal indices and GCF TNF-a levels. Thus, suppression of pro-inflammatory cytokines might prove beneficial in suppressing periodontal diseases.