Published Online
on July 1, 2004

A more recent version of this article appeared on September 1, 2004

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Submitted on December 16, 2003
Revised on May 14, 2004
Accepted on May 27, 2004

Antibodies to Periodontal Pathogens and Stroke Risk

Pirkko J. Pussinen PhD^*; Georg Alfthan PhD; Harri Rissanen MSc; Antti Reunanen MD; Sirkka Asikainen DDS; and Paul Knekt PhD

From the Institute of Dentistry (P.J.P.), University of Helsinki, and Department of Oral and Maxillofacial Diseases, Helsinki University Central Hospital, Finland; the Department of Health and Functional Ability (G.A., H.R., A.R., P.K.), National Public Health Institute, Helsinki, Finland; the Adhesion Center (S.A.), Oral Microbiology, Department of Medicine and Odontology, Umeå University, Sweden.

^* To whom correspondence should be addressed. E-mail: pirkko.pussinen{at}helsinki.fi.

Background and Purpose--The association between cerebrovascular events and periodontitis has been found in few studies based on clinical periodontal examinations. However, evidence on the association between periodontal pathogens and stroke is lacking. Therefore, the aim of the study was to investigate whether elevated levels of serum antibodies to major periodontal pathogens predict stroke in a case-control study.

Methods--The study population comprised 6950 subjects (aged 45 to 64 years) who participated in the Mobile Clinic Health Survey in 1973 to 1976 in Finland. During a follow-up of 13 years, a total of 173 subjects had a stroke. From these, 64 subjects had already experienced a stroke or had signs of coronary heart disease (CHD) at baseline, whereas 109 subjects were apparently healthy. Two controls per case were matched for age, gender, municipality, and disease status. Serum IgG and IgA class antibody levels to the periodontal pathogens, Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis, were determined by multiserotype enzyme-linked immunosorbent assay.

Results--The cases identified during the follow-up that were free of stroke or CHD at baseline were more often IgA-seropositive for A. actinomycetemcomitans than were their controls, 41.3% versus 29.3%. Compared with the seronegative, the seropositive subjects had a multivariate odds ratio of 1.6 (95% CI, 1.0 to 2.6) for stroke. The patients with a history of stroke or CHD at baseline were more often IgA-seropositive for P. gingivalis than were their controls, 79.7% versus 70.2%. When compared with the seronegative, the seropositive subjects had an odds ratio of 2.6 (1.0 to 7.0) for secondary stroke.

Conclusions--The present prospective study provides serological evidence that an infection caused by major periodontal pathogens is associated with future stroke.

Key words: epidemiology • cerebrovascular disorders • risk factors • stroke

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