A case‐control study on periodontitis and left ventricular function in patients with diabetes

Abstract

Background & Aim: Periodontal disease is closely linked to diabetes and cardiovascular disease, while the potential pathology and mechanisms involved in impaired cardiovascular function in patients with both periodontitis and diabetes remain unclear. This study aimed to investigate whether chronic periodontitis in patients with diabetes could be related to myocardial function and serological cardiac biomarkers.

Methods: Seventy non‐smoking type 2 diabetic patients without cardiovascular complications were recruited, including 35 periodontitis subjects and 35 controls with matched age, gender and HbA1c levels. Following full‐mouth periodontal examination, echocardiography was performed to assess i) Left ventricle (LV) diastolic function by E/e’ defined as the ratio of trans‐mitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity; ii) LV systolic function by LV ejection fraction and speckle tracking derived global longitudinal strain (GLS); and iii) LV hypertrophy by LV mass index (LVMi). Cardiac stress‐related serological biomarkers were also measured, including Soluble ST2 (sST2) and N‐terminal fragment of brain natriuretic peptide (NT‐BNP).

Results: Overall, the periodontitis patients exhibited higher levels of GLS and E/e’ ratio, along with increased concentrations of sST2 and NT‐BNP, with reference to those in the controls (p < 0.01). No significant difference in LVMi was found between the two groups. Univariate analysis showed that periodontitis and related variables including probing depth and clinical attachment loss were significantly associated with both GLS and E/e’ ratio (p < 0.05). Notably, the presence of periodontitis remained to be significantly correlated with GLS after adjusting for confounders (β = 1.30, 95% CI 0.37–2.24, p < 0.01).

Conclusion: This case‐control study shows for the first time that periodontitis is independently associated with impaired myocardial systolic function in diabetes patients, which may increase the risk for developing adverse cardiovascular outcomes and other diabetic complications.