High dose atorvastatin also beneficial for gum disease
High Dose Atorvastatin Reduces Periodontal Inflammation: A Novel Pleiotropic Effect of Statins.
Subramanian S, Emami H, Vucic E et al.
J Am Coll Cardiol. 2013 Sep 23. doi: 10.1016/j.jacc.2013.08.1627. [Epub ahead of print]
BackgroundPeriodontal disease (PD) is a common, independent risk factor for atherosclerotic disease [1,2]. Local periodontal inflammation, through pro-inflammatory cytokine release, has been proposed to lead to systemic inflammation, as measured by CRP, TNA-α, IL-6 and other biomarkers. This is one of the postulated pathogenic mechanisms linkin PD and cardiovascular (CV) disease [3-5]. Increased levels of circulating inflammatory mediators can then promote inflammatory activity within atherosclerotic plaques [6,7].
Local treatment of PD has been shown to reduce systemic inflammation in patients with a history of CV events . No definitive evidence exists, however, that treatment of periodontal disease decreases CV disease progression or CV events.
18F-Flurodeoxyglucose positron emission tomography (FDG-PET) imaging provides a non-invasive measure of inflammation, also of inflammatory activity within atherosclerotic plaques. The authors have previously shown that periodontal inflammation correlates with carotid artery inflammation . Others have recently demonstrated that periodontal FDG uptake correlates with PD severity as measured by alveolar bone loss .
Retrospective epidemiologic studies have shown that statin therapy is associated with reduced severity of periodontitis [11-14]. Furthermore, it was shown recently that a combination of statins and standard local periodontal treatment was more effective than the local treatment alone .
This double-blind, randomised, active-comparator study aimed to study the direct anti-inflammatory actions of statins in periodontal tissue, by using FDG-PET/CT imaging to test if high-dose atorvastatin treatment lowers periodontal disease activity, similar to its action on atherosclerotic plaque activity. 71 subjects completed the study, and for 59 of those periodontal tissue images were available.
- Mean periodontal FDG uptake was significantly reduced in the entire cohort after 12 weeks of treatment with high (80 mg) vs. low (10 mg) dose atorvastatin (mean Target-to-background ratio (TBR): -0.29 + 0.85 (SD) vs. 0.13 + 0.68, P0.04). The effect of high dose atorvastatin on PD activity remained statistically significant after correction for several possible confounders.
- The effect of high-dose statin treatment was more pronounced in subjects with imaging evidence of periodontal disease at baseline; in individuals with active periodontitis there were clear differences between the two statin doses (change TBR= -0.52 + 0.94 vs. 0.22 + 0.79, P=0.01). The difference between groups was already evident after 4 weeks.
- Baseline FDG uptake (TBR) in periodontal tissue correlated with baseline carotid plaque TBR. Also, after 12 weeks of statin treatment, changes in periodontal inflammation correlated with changes in carotid inflammation.
- Baseline PD activity (periodontal TBR) was inversely correlated with baseline HDL concentration (r= -0.35, P=0.007), but did not correlate with baseline CRP or LDL levels. Changes in PD activity did not correlate with changes in CRP, LDL or HDL.
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ConclusionTwelve weeks of high-dose statin therapy significantly reduces periodontal inflammation. The reduction in PD activity was already seen after 4 weeks of atorvastatin treatment and correlated with changes in FDG uptake in the carotid wall.
It has previously been suggested that statins have effects beyond their lipid-lowering actions. This study provides evidence for a cholesterol-independent, or ‘pleiotropic’ effect of statins, namely reduction in non-arterial inflammation. The authors further postulate that a reduction in local periodontal inflammation may also exert beneficial effects on the systemic arterial milieu, through a reduced release of pro-inflammatory mediators from the periodontal tissue, into the systemic circulation.
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