By Serena Gordon
Using advanced imaging techniques, researchers were able to see that when people with gum disease took higher doses of the commonly prescribed cholesterol-lowering drugs, their gum inflammation decreased.
During the 12-week study, the researchers also looked for evidence of inflammation or hardening of the blood vessels (atherosclerotic disease) in the study volunteers, and they found that reduced gum inflammation was correlated with improved blood vessel health.
"There is a building, growing body of literature that draws a line between gum disease and atherosclerotic disease. In our study, benefits in the gums correlated with benefits in the arteries," said the study's senior author, Dr. Ahmed Tawakol, co-director of the Cardiac Imaging Trials Program at Massachusetts General Hospital and Harvard Medical School in Boston. "People with [gum disease] and atherosclerotic disease should likely be that much more vigilant in treating their gum disease."
The study was published online Oct. 2 in the Journal of the American College of Cardiology. Funding was provided by drug manufacturer Merck and Co., which does not produce the statin used in this study.
Currently, statins are prescribed to lower high levels of "bad" cholesterol, also known as LDL cholesterol. When there's too much LDL cholesterol, it can start to build up on blood vessel walls, leading to hardening of the arteries.
In the United States, more than 30 million people take statins, and as many as 200 million people worldwide take these cholesterol-lowering medications, according to a journal editorial accompanying the study. Periodontal disease (or gum disease) affects nearly half of U.S. adults.
According to editorial author Dr. Michael Blaha, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease in Baltimore, a "consistent stream of data" shows that statins have benefits beyond their cholesterol-lowering properties.
"There are three big categories of how statins likely exert their effects: lowering LDL, reducing inflammation, and by modulating plaque," said Blaha.
The current study lends support to the idea that statins can reduce inflammation. It included 83 adults who had risk factors for, or already had, atherosclerosis. They were randomly assigned to take either 10 or 80 milligrams of a statin called atorvastatin (brand name Lipitor) for three months.
Everyone underwent imaging at the start of the study, again after four weeks and then at 12 weeks.
At the end of the study, the investigators had complete data on 59 people. They found a significant reduction in gum inflammation for the people taking 80 mg of atorvastatin compared to those on the 10-mg dose. Changes began as early as four weeks after people started taking the higher-dose drug.
There was a more significant reduction in gum inflammation for people who had more serious gum disease at the start of the study and took a higher dose of the statin. The researchers also found that a reduction in gum inflammation correlated with reduced blood vessel inflammation.
"It was really those on the higher-dose statins that had the benefit," noted Tawakol. But, "I would not recommend the use of statins outside the current guidelines," he added. "We see this trial more as a proof-of-principle trial. Our findings need to be confirmed in a larger clinical trial."
Still, he said, there's little harm in telling people to take care of gum disease. "Patients with known heart disease and known gum disease should have their gum disease evaluated and treated," Tawakol said.
Blaha agreed that it's too soon to change practice guidelines either for treating heart disease risk factors or for gum disease.
Still, "this study and others like it have tremendous implications," Blaha said. "We've never had a drug that worked this well and for so many different groups of patients."