Although the etiology of essential hypertension is not clearly understood, endothelial dysfunction from chronic infection and/or impaired glucose metabolism may be involved. We hypothesized that salivary lysozyme, a marker for oral infection and hyperglycemia, might display a significant relationship with hypertension, an early stage of cardiovascular disease. Logistic regression analyses of the Kuopio Oral Health and Heart Study demonstrated that persons with higher lysozyme levels were more likely to have hypertension, after adjustment for age, gender, smoking, BMI, diabetes, the ratio of total cholesterol to HDL cholesterol, and C-reactive protein. The exposure to increasing quartiles of lysozyme was associated with adjusted Odds Ratios for the outcome, hypertension, 1.00 (referent), 1.25, 1.42, and 2.56 (linear trend p < 0.003). When we restricted the sample to the individuals without heart disease (N = 250), we observed a non-significant trend for increasing odds. Our hypothesis—“high salivary lysozyme levels are associated with the odds of hypertension”—was confirmed.
Get full access to this article
View all access options for this article.
References
1.
AHA -2004-. Heart disease and stroke statistics—2005 update. Statistical fact sheets. Dallas, TX: American Heart Association.
2.
Bautista LE -2003-. Inflammation, endothelial dysfunction, and the risk of high blood pressure: epidemiologic and biological evidence. J Hum Hypertens17:223–230.
3.
Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S -1996-. Periodontal disease and cardiovascular disease. J Periodontol67-10 Suppl-:1123S–1137S.
4.
Clearfield M, Whitney EJ, Weis S, Downs JR, Shapiro DR, Stein EA, et al. -2000-. Air Force/Texas Coronary Atherosclerosis Prevention Study -AFCAPS/TexCAPS-: baseline characteristics and comparison with USA population. J Cardiovasc Risk7:125–133.
5.
Collin HL, Uusitupa M, Niskanen L, Kontturi-Närhi V, Markkanen H, Koivisto AM, et al. -1998-. Periodontal findings in elderly patients with non-insulin dependent diabetes mellitus. J Periodontol69:962–966.
6.
Collin HL, Sorsa T, Meurman JH, Niskanen L, Salo T, Ronka H, et al. -2000-. Salivary matrix metalloproteinase -MMP-8- levels and gelatinase -MMP-9- activities in patients with type 2 diabetes mellitus. J Periodontal Res35:259–265.
7.
Cutler CW, Machen RL, Jotwani R, Iacopino AM -1999-. Heightened gingival inflammation and attachment loss in type 2 diabetics with hyperlipidemia. J Periodontol70:1313–1321.
8.
Doll S, Paccaud F, Bovet P, Burnier M, Wietlisbach V -2002-. Body mass index, abdominal adiposity and blood pressure: consistency of their association across developing and developed countries. Int J Obes Relat Metabol Disord26:48–57.
9.
Grundy SM -2003-. Inflammation, hypertension, and the metabolic syndrome. J Am Med Assoc290:3000–3002.
10.
Janket SJ, Qvarnstrom M, Meurman JH, Baird AE, Nuutinen P, Jones JA -2004-. Asymptotic dental score and prevalent coronary heart disease. Circulation109:1095–1100.
11.
Janket SJ, Meurman JH, Nuutinen P, Qvarnstrom M, Nunn ME, Baird AE, et al. -2006-. Salivary lysozyme and prevalent coronary heart disease: possible effects of oral health on endothelial dysfunction. Arterioscler Thromb Vasc Biol26:433–434.
12.
Janket SJ, Jones JA, Meurman JH, Baird AE, Van Dyke TE -2007a-. Oral infection, hyperglycemia and endothelial dysfunction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod105:173–179.
13.
Janket SJ, Shen Y, Meurman JH -2007b-. “Use and misuse of receiver operating characteristic -ROC- curve” revisited -comments/letter-. Circulation116:133; comment on Circulation 115:928–935.
14.
Johansson I, Tidehag P, Lundberg V, Hallmans G -1994-. Dental status, diet and cardiovascular risk factors in middle-aged people in northern Sweden. Community Dent Oral Epidemiol22:431–436.
15.
Joshipura KJ, Rimm EB, Douglass CW, Trichopoulos D, Ascherio A, Willett WC -1996-. Poor oral health and coronary heart disease. J Dent Res75:1631–1636.
16.
Karima M, Kantarci A, Ohira T, Hasturk H, Jones VL, Nam BH, et al. -2005-. Enhanced superoxide release and elevated protein kinase C activity in neutrophils from diabetic patients: association with periodontitis. J Leukoc Biol78:862–870.
17.
Klempner MS, Malech HL -1998-. Phagocytes: normal and abnormal neutrophil host defenses. In: Infectious diseases. Gorbach SL, Bartlett JG, Blacklow NR, editors. Philadelphia: WB Saunders Co., pp. 41–47.
18.
Kurtis B, Develioglu H, Taner IL, Balos K, Tekin IO -1999-. IL-6 levels in gingival crevicular fluid -GCF- from patients with non-insulin dependent diabetes mellitus -NIDDM-, adult periodontitis and healthy subjects. J Oral Sci41:163–167.
19.
Liu S, Willett WC -2002-. Dietary glycemic load and atherothrombotic risk. Curr Atheroscler Rep4:454–461.
20.
Losche W, Karapetow F, Pohl A, Pohl C, Kocher T -2000-. Plasma lipid and blood glucose levels in patients with destructive periodontal disease. J Clin Periodontol27:537–541.
21.
Margolis KL, Manson JE, Greenland P, Rodabough RJ, Bray PF, Safford M, et al. -2005-. Leukocyte count as a predictor of cardiovascular events and mortality in postmenopausal women: the Women’s Health Initiative Observational Study. Arch Intern Med165:500–508.
22.
Miller LS, Manwell MA, Newbold D, Reding ME, Rasheed A, Blodgett J, et al. -1992-. The relationship between reduction in periodontal inflammation and diabetes control: a report of 9 cases. J Periodontol63:843–848.
23.
Nishimura F, Terranova V, Foo H, Kurihara M, Kurihara H, Murayama Y -1996-. Glucose-mediated alteration of cellular function in human periodontal ligament cells. J Dent Res75:1664–1671.
24.
Pickup JC -2004-. Inflammation and activated innate immunity in the pathogenesis of type 2 diabetes. Diabetes Care27:813–823.
25.
Reaven G -2002-. Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation106:286–288.
26.
Ridker PM, Buring JE, Shih J, Matias M, Hennekens CH -1998-. Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation98:731–733.
27.
Rudney JD, Smith QT -1985-. Relationships between levels of lysozyme, lactoferrin, salivary peroxidase, and secretory immunoglobulin A in stimulated parotid saliva. Infect Immun49:469–475.
28.
Salvi GE, Yalda B, Collins JG, Jones BH, Smith FW, Arnold RR, et al. -1997-. Inflammatory mediator response as a potential risk marker for periodontal diseases in insulin-dependent diabetes mellitus patients. J Periodontol68:127–135.
29.
Sandberg GE, Sundberg HE, Fjellstrom CA, Wikblad KF -2000-. Type 2 diabetes and oral health: a comparison between diabetic and non-diabetic subjects. Diabetes Res Clin Pract50:27–34.
30.
Tervonen T, Oliver RC, Wolff LF, Bereuter J, Anderson L, Aeppli DM -1994-. Prevalence of periodontal pathogens with varying metabolic control of diabetes mellitus. J Clin Periodontol21:375–379.
Vlassara H, Palace MR -2003-. Glycoxidation: the menace of diabetes and aging. Mt Sinai J Med70:232–241.
33.
Vlassara H, Cai W, Crandall J, Goldberg T, Oberstein R, Dardaine V, et al. -2002-. Inflammatory mediators are induced by dietary glycotoxins, a major risk factor for diabetic angiopathy. Proc Natl Acad Sci USA99:15596–15601; erratum in Proc Natl Acad Sci USA 100:763, 2003.
34.
Yalda B, Offenbacher S, Collins JG -1994-. Diabetes as a modifier of periodontal disease expression. Periodontol 20006:37–49.
35.
Zheng F, Cai W, Mitsuhashi T, Vlassara H -2001-. Lysozyme enhances renal excretion of advanced glycation endproducts in vivo and suppresses adverse age-mediated cellular effects in vitro: a potential AGE sequestration therapy for diabetic nephropathy? Mol Med7:737–747.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
