Spielt die marginale Parodontitis eine Rolle in der Pathogenese kardio- und zerebrovaskulärer Erkrankungen?

Zusammenfassung

Die Bedeutung chronischer Infektionen bei der Entstehung atherosklerotischer Läsionen war in den vergangenen Jahren ein heiß diskutiertes Thema. Eine mögliche ursächliche Beziehung kardiovaskulärer Erkrankungen zu Infektionen mit Chlamydia pneumoniae, Helicobacter pylori oder Herpesviren wurde insbesondere nach dem Nachweis von DNA-typischen Parodontalpathogenen in atheromatösen Plaques auf die marginale Parodontitis ausgedehnt. Vor allem in longitudinalen epidemiologischen Studien wurden geringe bis mäßig starke Assoziationen zwischen einer bestehenden Parodontitis und der Entwicklung von z. B. koronarer Herzerkrankung oder nichthämorrhagischem Apoplex gefunden. In der vorliegenden Übersicht sollen die bisher publizierten Daten einer kritischen Beurteilung unterzogen werden. Insbesondere soll der Einfluss einer nicht erfolgten oder ungeeigneten Berücksichtigung von gemeinsamen Risikofaktoren für kardiovaskuläre Erkrankungen und Parodontitis auf die beobachteten Assoziationen untersucht werden. Metaanalysen prospektiver Untersuchungen, in denen das Zielereignis nach Beginn der Studie auftrat, ergaben eine Erhöhung des Risikos bei Vorliegen einer chronischen Parodontitis um den Faktor 1,12 (95 %-Konfidenzinterval 0,95-1,33) für koronare Herzerkrankung und 1,73 (0,89-3,34) für ischämischen Schlaganfall. Ob die marginale Parodontitis ein Risiko für die Entwicklung kardiovaskulärer Erkrankungen darstellt, bleibt nach wie vor eine offene Frage. Bereits geplante Interventionsstudien müssen daher als voreilig und ethisch höchst fragwürdig angesehen werden.

Abstract

The role of chronic infections in the initiation of atherosclerotic lesions has been vividly discussed in recent years. A possible causal relationship between cardiovascular diseases and infections with, e. g., Chlamydia pneumoniae, Helicobacter pylori, or herpes viruses had also been established for chronic periodontitis, in particular after discovery of DNA of typical periodontal pathogens in atheromatous plaques. Especially in longitudinal epidemiologic studies, a low or moderate association between existing periodontitis and the development of, e. g., coronary heart disease or non-haemorrhagic stroke had been observed. In this article the respective literature is critically reviewed. In particular, the influence of incomplete or inappropriate adjustment for common risk factors for both diseases, i. e., cardiovascular disease and periodontitis should be analysed. In metaanalyses of prospective studies, in which the respective endpoint occurred after the investigation had commenced, relative risks of periodontitis of 1.12 (95 % confidence interval 0.95-1.33) for coronary heart disease and 1.73 (0.89-3.34) for ischaemic stroke were calculated. Whether chronic periodontitis actually represents an important risk for the development of cardiovascular diseases remains questionable. Already planned intervention studies appear to be premature and ethically highly problematic.

Schlüsselwörter

Parodontitis - Koronare Herzerkrankung - Zerebrovaskuläre Ischämie - Chronische Infektion - Entzündung - Pathogenese - Risikofaktor - Metaanalyse

Key words

Periodontitis - Coronary Heart Disease - Cerebrovascular Ischaemia - Chronic Infection - Inflammation - Pathogenesis - Risk Factor - Metaanalysis

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1 Ergebnisse der einzelnen Studien werden als relative Risiken (Größe der schwarzen Quadrate in Relation zur Anzahl der Fälle) und 99%-Konfidenzintervalle angegeben, Ergebnisse der Metaanalysen als Rauten (relatives Risiko und 95%-Konfidenzintervall). Grad der Berücksichtigung von möglichen Confoundern: *****: demographische Einflussfaktoren, sozioökonomische Faktoren, klassische Risikofaktoren für koronare beziehungsweise zerebrovaskuläre Erkrankungen; ****: demographische Faktoren und klassische Risikofaktoren für CHD und CVD; *** und **: demographische Faktoren und einige klassische Risikofaktoren für CHD/CVD.