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March 2002
Periodontitis and Heart Disease
The question of whether gum disease is associated with heart disease
is controversial. The first research to suggest a connection, published
in 1989, found that even after controlling for such cardiovascular disease
risk factors as smoking and diabetes, heart-attack patients had significantly
worse dental health than control subjects. Since then, several studies
have also suggested a link, but the nature of the relationship —
is it causative or coincidental? — remains in question.
In 2001, researchers sought an answer to this question, examining data
from 4,027 people who participated in the First National Health and Nutrition
Examination Survey Epidemiologic Follow-up Study. During 17 years of follow-up,
there were 1,238 cases of heart disease, 538 of which proved fatal. The
rate of heart disease was three times higher in those with periodontitis
than in those with healthy gums.
However, the connection became less prominent once investigators adjusted
the numbers to account for other risk factors for cardiovascular disease
— smoking, cholesterol levels, high blood pressure, and diabetes.
After this adjustment, the heart disease risk among people with and without
chronic dental infections was similar.
In fact, even those people who had eliminated any potential of dental
infection through extraction of all teeth didn't have a lower heart disease
risk when compared to those diagnosed with periodontitis (inflammation
of the gums). The risk of developing CHD didn't decrease over time among
those with no dental infections or increase over time among people with
periodontitis.
A higher rate of other heart-disease risk factors among people with periodontitis
might explain this relationship between gum disease and heart disease.
For example, those with periodontitis were more likely to have high blood
pressure and diabetes, and to smoke cigarettes.
These findings support the theory that the presence of periodontitis may
occur coincidentally with increased cardiovascular risk but it is not
its cause.
March 2002 Update
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New Drugs Have Had Impact on Glaucoma
Therapy
Glaucoma strikes nearly 4 million people in the United States,
and is a major cause of blindness. It is characterized by excessive fluid
pressure in the eye, which can damage the optic nerve. The good news is
that when caught and treated early, vision can usually be spared.
Glaucoma can be treated either with medications or with surgery. Until
recently, physicians primarily treated glaucoma with topical ß blockers,
which reduced the amount of fluid, called aqueous humor, produced
in the eye. When drugs were not effective, a surgical procedure would
be used to improve drainage of the fluid. Over the past five years, however,
three new classes of glaucoma medications have come into use: prostaglandin
analogues (latanoprost), which remove aqueous humor through the uveal
tissues; topical carbonic anhydrase inhibitors (dorzolamide), which reduce
the amount of aqueous humor produced in the eye; and α-2 agonists
(brimonidine), which decrease production of aqueous humor and increase
fluid outflow.
Investigators in Scotland set out to determine the impact that these new
classes of drugs have had on the treatment of glaucoma. They reviewed
a national registry that recorded the prescription and surgery statistics
for Scotland from 1989 through 1999. The researchers found that the number
of surgical procedures performed per 1,000 glaucoma patients increased
between the years 1989 and 1994, then decreased by 45.9% from 1994 through
1999. During the same period (1994–1999), the number of medications
prescribed per 1,000 glaucoma patients increased by 24.9%, mostly due
to a rise in the prescription of the new drug classes.
Although the new drugs have altered the medical and surgical treatment
of glaucoma, the researchers note that it is still too early to tell whether
the new medications will prevent the need for surgery, or only delay it.
March 2002 Update
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