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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Arterial Stiffness and Pulse Wave Reflection Are Increased in Patients Suffering from Severe Periodontitis</title><author><name sortKey="Jockel Schneider, Yvonne" sort="Jockel Schneider, Yvonne" uniqKey="Jockel Schneider Y" first="Yvonne" last="Jockel-Schneider">Yvonne Jockel-Schneider</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Harks, Inga" sort="Harks, Inga" uniqKey="Harks I" first="Inga" last="Harks">Inga Harks</name><affiliation><nlm:aff id="aff2"><addr-line>Department of Periodontology, University Hospital Muenster, Muenster, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Haubitz, Imme" sort="Haubitz, Imme" uniqKey="Haubitz I" first="Imme" last="Haubitz">Imme Haubitz</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Fickl, Stefan" sort="Fickl, Stefan" uniqKey="Fickl S" first="Stefan" last="Fickl">Stefan Fickl</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Eigenthaler, Martin" sort="Eigenthaler, Martin" uniqKey="Eigenthaler M" first="Martin" last="Eigenthaler">Martin Eigenthaler</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Schlagenhauf, Ulrich" sort="Schlagenhauf, Ulrich" uniqKey="Schlagenhauf U" first="Ulrich" last="Schlagenhauf">Ulrich Schlagenhauf</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Baulmann, Johannes" sort="Baulmann, Johannes" uniqKey="Baulmann J" first="Johannes" last="Baulmann">Johannes Baulmann</name><affiliation><nlm:aff id="aff3"><addr-line>Clinic of Internal Medicine II, University Hospital Schleswig-Holstein, Luebeck, Germany</addr-line></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25084111</idno><idno type="pmc">4119014</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4119014</idno><idno type="RBID">PMC:4119014</idno><idno type="doi">10.1371/journal.pone.0103449</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">000021</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000021</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Arterial Stiffness and Pulse Wave Reflection Are Increased in Patients Suffering from Severe Periodontitis</title><author><name sortKey="Jockel Schneider, Yvonne" sort="Jockel Schneider, Yvonne" uniqKey="Jockel Schneider Y" first="Yvonne" last="Jockel-Schneider">Yvonne Jockel-Schneider</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Harks, Inga" sort="Harks, Inga" uniqKey="Harks I" first="Inga" last="Harks">Inga Harks</name><affiliation><nlm:aff id="aff2"><addr-line>Department of Periodontology, University Hospital Muenster, Muenster, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Haubitz, Imme" sort="Haubitz, Imme" uniqKey="Haubitz I" first="Imme" last="Haubitz">Imme Haubitz</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Fickl, Stefan" sort="Fickl, Stefan" uniqKey="Fickl S" first="Stefan" last="Fickl">Stefan Fickl</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Eigenthaler, Martin" sort="Eigenthaler, Martin" uniqKey="Eigenthaler M" first="Martin" last="Eigenthaler">Martin Eigenthaler</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Schlagenhauf, Ulrich" sort="Schlagenhauf, Ulrich" uniqKey="Schlagenhauf U" first="Ulrich" last="Schlagenhauf">Ulrich Schlagenhauf</name><affiliation><nlm:aff id="aff1"><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></nlm:aff></affiliation></author><author><name sortKey="Baulmann, Johannes" sort="Baulmann, Johannes" uniqKey="Baulmann J" first="Johannes" last="Baulmann">Johannes Baulmann</name><affiliation><nlm:aff id="aff3"><addr-line>Clinic of Internal Medicine II, University Hospital Schleswig-Holstein, Luebeck, Germany</addr-line></nlm:aff></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Aim</title><p>This single blind cross-sectional study compared the vascular health of subjects suffering from severe chronic periodontitis, severe aggressive periodontitis and periodontal healthy controls by evaluating pulse wave velocity (PWV), augmentation index (AIx) and pulse pressure amplification (PPA).</p></sec><sec><title>Material and Methods</title><p>In a total of 158 subjects, 92 suffering from severe periodontitis and 66 matched periodontal healthy controls, PWV, AIx, central and peripheral blood pressure were recorded using an oscillometric device (Arteriograph).</p></sec><sec><title>Results</title><p>Subjects suffering from severe chronic or aggressive periodontitis exhibited significantly higher PWV (p = 0.00004), higher AIx (p = 0.0049) and lower PPA (p = 0.028) than matched periodontal healthy controls.</p></sec><sec><title>Conclusions</title><p>The results of this study confirm the association between periodontal inflammation and increased cardiovascular risk shown by impaired vascular health in case of severe periodontitis. As impaired vascular health is a common finding in patients suffering from severe periodontal disease a concomitant routine cardiovascular evaluation may be advised.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Mattila, Kj" uniqKey="Mattila K">KJ Mattila</name></author><author><name sortKey="Nieminen, Ms" uniqKey="Nieminen M">MS Nieminen</name></author><author><name sortKey="Valtonen, Vv" uniqKey="Valtonen V">VV Valtonen</name></author><author><name sortKey="Rasi, Vp" uniqKey="Rasi V">VP Rasi</name></author><author><name sortKey="Kesaniemi, Ya" uniqKey="Kesaniemi Y">YA Kesaniemi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Syrjanen, J" uniqKey="Syrjanen J">J Syrjanen</name></author><author><name sortKey="Peltola, J" uniqKey="Peltola J">J Peltola</name></author><author><name sortKey="Valtonen, V" uniqKey="Valtonen V">V Valtonen</name></author><author><name sortKey="Iivanainen, M" uniqKey="Iivanainen M">M Iivanainen</name></author><author><name sortKey="Kaste, M" uniqKey="Kaste M">M Kaste</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Humphrey, Ll" uniqKey="Humphrey L">LL Humphrey</name></author><author><name sortKey="Fu, R" uniqKey="Fu R">R Fu</name></author><author><name sortKey="Buckley, Di" uniqKey="Buckley D">DI Buckley</name></author><author><name sortKey="Freeman, M" uniqKey="Freeman M">M Freeman</name></author><author><name sortKey="Helfand, M" uniqKey="Helfand M">M Helfand</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Janket, Sj" uniqKey="Janket S">SJ Janket</name></author><author><name sortKey="Baird, Ae" uniqKey="Baird A">AE Baird</name></author><author><name sortKey="Chuang, Sk" uniqKey="Chuang S">SK Chuang</name></author><author><name sortKey="Jones, Ja" uniqKey="Jones J">JA Jones</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kebschull, M" uniqKey="Kebschull M">M Kebschull</name></author><author><name sortKey="Demmer, Rt" uniqKey="Demmer R">RT Demmer</name></author><author><name sortKey="Papapanou, Pn" uniqKey="Papapanou P">PN Papapanou</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Elter, Jr" uniqKey="Elter J">JR Elter</name></author><author><name sortKey="Hinderliter, Al" uniqKey="Hinderliter A">AL Hinderliter</name></author><author><name sortKey="Offenbacher, S" uniqKey="Offenbacher S">S Offenbacher</name></author><author><name sortKey="Beck, Jd" uniqKey="Beck J">JD Beck</name></author><author><name sortKey="Caughey, M" uniqKey="Caughey M">M Caughey</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mercanoglu, F" uniqKey="Mercanoglu F">F Mercanoglu</name></author><author><name sortKey="Oflaz, H" uniqKey="Oflaz H">H Oflaz</name></author><author><name sortKey="Oz, O" uniqKey="Oz O">O Oz</name></author><author><name sortKey="Gokbuget, Ay" uniqKey="Gokbuget A">AY Gokbuget</name></author><author><name sortKey="Genchellac, H" uniqKey="Genchellac H">H Genchellac</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Seinost, G" uniqKey="Seinost G">G Seinost</name></author><author><name sortKey="Wimmer, G" uniqKey="Wimmer G">G Wimmer</name></author><author><name sortKey="Skerget, M" uniqKey="Skerget M">M Skerget</name></author><author><name sortKey="Thaller, E" uniqKey="Thaller E">E Thaller</name></author><author><name sortKey="Brodmann, M" uniqKey="Brodmann M">M Brodmann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tonetti, Ms" uniqKey="Tonetti M">MS Tonetti</name></author><author><name sortKey="D Aiuto, F" uniqKey="D Aiuto F">F D'Aiuto</name></author><author><name sortKey="Nibali, L" uniqKey="Nibali L">L Nibali</name></author><author><name sortKey="Donald, A" uniqKey="Donald A">A Donald</name></author><author><name sortKey="Storry, C" uniqKey="Storry C">C Storry</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ferrari, Au" uniqKey="Ferrari A">AU Ferrari</name></author><author><name sortKey="Radaelli, A" uniqKey="Radaelli A">A Radaelli</name></author><author><name sortKey="Centola, M" uniqKey="Centola M">M Centola</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Safar, H" uniqKey="Safar H">H Safar</name></author><author><name sortKey="Mourad, Jj" uniqKey="Mourad J">JJ Mourad</name></author><author><name sortKey="Safar, M" uniqKey="Safar M">M Safar</name></author><author><name sortKey="Blacher, J" uniqKey="Blacher J">J Blacher</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Blacher, J" uniqKey="Blacher J">J Blacher</name></author><author><name sortKey="Guerin, Ap" uniqKey="Guerin A">AP Guerin</name></author><author><name sortKey="Pannier, B" uniqKey="Pannier B">B Pannier</name></author><author><name sortKey="Marchais, Sj" uniqKey="Marchais S">SJ Marchais</name></author><author><name sortKey="Safar, Me" uniqKey="Safar M">ME Safar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cruickshank, K" uniqKey="Cruickshank K">K Cruickshank</name></author><author><name sortKey="Riste, L" uniqKey="Riste L">L Riste</name></author><author><name sortKey="Anderson, Sg" uniqKey="Anderson S">SG Anderson</name></author><author><name sortKey="Wright, Js" uniqKey="Wright J">JS Wright</name></author><author><name sortKey="Dunn, G" uniqKey="Dunn G">G Dunn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Boutouyrie, P" uniqKey="Boutouyrie P">P Boutouyrie</name></author><author><name sortKey="Tropeano, Ai" uniqKey="Tropeano A">AI Tropeano</name></author><author><name sortKey="Asmar, R" uniqKey="Asmar R">R Asmar</name></author><author><name sortKey="Gautier, I" uniqKey="Gautier I">I Gautier</name></author><author><name sortKey="Benetos, A" uniqKey="Benetos A">A Benetos</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Meaume, S" uniqKey="Meaume S">S Meaume</name></author><author><name sortKey="Benetos, A" uniqKey="Benetos A">A Benetos</name></author><author><name sortKey="Henry, Of" uniqKey="Henry O">OF Henry</name></author><author><name sortKey="Rudnichi, A" uniqKey="Rudnichi A">A Rudnichi</name></author><author><name sortKey="Safar, Me" uniqKey="Safar M">ME Safar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mitchell, Gf" uniqKey="Mitchell G">GF Mitchell</name></author><author><name sortKey="Hwang, Sj" uniqKey="Hwang S">SJ Hwang</name></author><author><name sortKey="Vasan, Rs" uniqKey="Vasan R">RS Vasan</name></author><author><name sortKey="Larson, Mg" uniqKey="Larson M">MG Larson</name></author><author><name sortKey="Pencina, Mj" uniqKey="Pencina M">MJ Pencina</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Vlachopoulos, C" uniqKey="Vlachopoulos C">C Vlachopoulos</name></author><author><name sortKey="Aznaouridis, K" uniqKey="Aznaouridis K">K Aznaouridis</name></author><author><name sortKey="Stefanadis, C" uniqKey="Stefanadis C">C Stefanadis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Willum Hansen, T" uniqKey="Willum Hansen T">T Willum-Hansen</name></author><author><name sortKey="Staessen, Ja" uniqKey="Staessen J">JA Staessen</name></author><author><name sortKey="Torp Pedersen, C" uniqKey="Torp Pedersen C">C Torp-Pedersen</name></author><author><name sortKey="Rasmussen, S" uniqKey="Rasmussen S">S Rasmussen</name></author><author><name sortKey="Thijs, L" uniqKey="Thijs L">L Thijs</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baulmann, J" uniqKey="Baulmann J">J Baulmann</name></author><author><name sortKey="Nurnberger, J" uniqKey="Nurnberger J">J Nurnberger</name></author><author><name sortKey="Slany, J" uniqKey="Slany J">J Slany</name></author><author><name sortKey="Schmieder, R" uniqKey="Schmieder R">R Schmieder</name></author><author><name sortKey="Schmidt Trucksass, A" uniqKey="Schmidt Trucksass A">A Schmidt-Trucksass</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Marchais, Sj" uniqKey="Marchais S">SJ Marchais</name></author><author><name sortKey="Guerin, Ap" uniqKey="Guerin A">AP Guerin</name></author><author><name sortKey="Pannier, Bm" uniqKey="Pannier B">BM Pannier</name></author><author><name sortKey="Levy, Bi" uniqKey="Levy B">BI Levy</name></author><author><name sortKey="Safar, Me" uniqKey="Safar M">ME Safar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Weber, T" uniqKey="Weber T">T Weber</name></author><author><name sortKey="Auer, J" uniqKey="Auer J">J Auer</name></author><author><name sortKey="O Rourke, Mf" uniqKey="O Rourke M">MF O'Rourke</name></author><author><name sortKey="Kvas, E" uniqKey="Kvas E">E Kvas</name></author><author><name sortKey="Lassnig, E" uniqKey="Lassnig E">E Lassnig</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="London, Gm" uniqKey="London G">GM London</name></author><author><name sortKey="Blacher, J" uniqKey="Blacher J">J Blacher</name></author><author><name sortKey="Pannier, B" uniqKey="Pannier B">B Pannier</name></author><author><name sortKey="Guerin, Ap" uniqKey="Guerin A">AP Guerin</name></author><author><name sortKey="Marchais, Sj" uniqKey="Marchais S">SJ Marchais</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Baulmann, J" uniqKey="Baulmann J">J Baulmann</name></author><author><name sortKey="Schillings, U" uniqKey="Schillings U">U Schillings</name></author><author><name sortKey="Rickert, S" uniqKey="Rickert S">S Rickert</name></author><author><name sortKey="Uen, S" uniqKey="Uen S">S Uen</name></author><author><name sortKey="Dusing, R" uniqKey="Dusing R">R Dusing</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Armitage, Gc" uniqKey="Armitage G">GC Armitage</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Page, Rc" uniqKey="Page R">RC Page</name></author><author><name sortKey="Eke, Pi" uniqKey="Eke P">PI Eke</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Grossi, Sg" uniqKey="Grossi S">SG Grossi</name></author><author><name sortKey="Dunford, Rg" uniqKey="Dunford R">RG Dunford</name></author><author><name sortKey="Ho, A" uniqKey="Ho A">A Ho</name></author><author><name sortKey="Koch, G" uniqKey="Koch G">G Koch</name></author><author><name sortKey="Machtei, Ee" uniqKey="Machtei E">EE Machtei</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Briggs, Je" uniqKey="Briggs J">JE Briggs</name></author><author><name sortKey="Mckeown, Pp" uniqKey="Mckeown P">PP McKeown</name></author><author><name sortKey="Crawford, Vl" uniqKey="Crawford V">VL Crawford</name></author><author><name sortKey="Woodside, Jv" uniqKey="Woodside J">JV Woodside</name></author><author><name sortKey="Stout, Rw" uniqKey="Stout R">RW Stout</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Morrison, Hi" uniqKey="Morrison H">HI Morrison</name></author><author><name sortKey="Ellison, Lf" uniqKey="Ellison L">LF Ellison</name></author><author><name sortKey="Taylor, Gw" uniqKey="Taylor G">GW Taylor</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tonetti, Ms" uniqKey="Tonetti M">MS Tonetti</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Franek, E" uniqKey="Franek E">E Franek</name></author><author><name sortKey="Klamczynska, E" uniqKey="Klamczynska E">E Klamczynska</name></author><author><name sortKey="Ganowicz, E" uniqKey="Ganowicz E">E Ganowicz</name></author><author><name sortKey="Blach, A" uniqKey="Blach A">A Blach</name></author><author><name sortKey="Budlewski, T" uniqKey="Budlewski T">T Budlewski</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sigurdsson, E" uniqKey="Sigurdsson E">E Sigurdsson</name></author><author><name sortKey="Sigfusson, N" uniqKey="Sigfusson N">N Sigfusson</name></author><author><name sortKey="Sigvaldason, H" uniqKey="Sigvaldason H">H Sigvaldason</name></author><author><name sortKey="Thorgeirsson, G" uniqKey="Thorgeirsson G">G Thorgeirsson</name></author><author><name sortKey="Silent, S" uniqKey="Silent S">S Silent</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ainamo, J" uniqKey="Ainamo J">J Ainamo</name></author><author><name sortKey="Barmes, D" uniqKey="Barmes D">D Barmes</name></author><author><name sortKey="Beagrie, G" uniqKey="Beagrie G">G Beagrie</name></author><author><name sortKey="Cutress, T" uniqKey="Cutress T">T Cutress</name></author><author><name sortKey="Martin, J" uniqKey="Martin J">J Martin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Micheelis, W" uniqKey="Micheelis W">W Micheelis</name></author><author><name sortKey="Hoffmann, T" uniqKey="Hoffmann T">T Hoffmann</name></author><author><name sortKey="Holtfreter, B" uniqKey="Holtfreter B">B Holtfreter</name></author><author><name sortKey="Schroeder, E" uniqKey="Schroeder E">E Schroeder</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dietrich, T" uniqKey="Dietrich T">T Dietrich</name></author><author><name sortKey="Jimenez, M" uniqKey="Jimenez M">M Jimenez</name></author><author><name sortKey="Krall Kaye, Ea" uniqKey="Krall Kaye E">EA Krall Kaye</name></author><author><name sortKey="Vokonas, Ps" uniqKey="Vokonas P">PS Vokonas</name></author><author><name sortKey="Garcia, Ri" uniqKey="Garcia R">RI Garcia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jimenez, M" uniqKey="Jimenez M">M Jimenez</name></author><author><name sortKey="Krall, Ea" uniqKey="Krall E">EA Krall</name></author><author><name sortKey="Garcia, Ri" uniqKey="Garcia R">RI Garcia</name></author><author><name sortKey="Vokonas, Ps" uniqKey="Vokonas P">PS Vokonas</name></author><author><name sortKey="Dietrich, T" uniqKey="Dietrich T">T Dietrich</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mceniery, Cm" uniqKey="Mceniery C">CM McEniery</name></author><author><name sortKey="Yasmin Hall, Ir" uniqKey="Yasmin Hall I">IR Yasmin, Hall</name></author><author><name sortKey="Qasem, A" uniqKey="Qasem A">A Qasem</name></author><author><name sortKey="Wilkinson, Ib" uniqKey="Wilkinson I">IB Wilkinson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Roman, Mj" uniqKey="Roman M">MJ Roman</name></author><author><name sortKey="Devereux, Rb" uniqKey="Devereux R">RB Devereux</name></author><author><name sortKey="Kizer, Jr" uniqKey="Kizer J">JR Kizer</name></author><author><name sortKey="Okin, Pm" uniqKey="Okin P">PM Okin</name></author><author><name sortKey="Lee, Et" uniqKey="Lee E">ET Lee</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25084111</article-id><article-id pub-id-type="pmc">4119014</article-id><article-id pub-id-type="publisher-id">PONE-D-14-13233</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0103449</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine and Health Sciences</subject><subj-group><subject>Oral Medicine</subject><subj-group><subject>Oral Diseases</subject><subj-group><subject>Periodontal Diseases</subject><subj-group><subject>Periodontitis</subject></subj-group></subj-group></subj-group><subj-group><subject>Oral Health</subject></subj-group></subj-group><subj-group><subject>Vascular Medicine</subject><subj-group><subject>Blood Pressure</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Arterial Stiffness and Pulse Wave Reflection Are Increased in Patients Suffering from Severe Periodontitis</article-title><alt-title alt-title-type="running-head">Vascular Health and Periodontitis</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Jockel-Schneider</surname><given-names>Yvonne</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Harks</surname><given-names>Inga</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Haubitz</surname><given-names>Imme</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Fickl</surname><given-names>Stefan</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Eigenthaler</surname><given-names>Martin</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Schlagenhauf</surname><given-names>Ulrich</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Baulmann</surname><given-names>Johannes</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Department of Periodontology, University Hospital Wuerzburg, Wuerzburg, Germany</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Department of Periodontology, University Hospital Muenster, Muenster, Germany</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Clinic of Internal Medicine II, University Hospital Schleswig-Holstein, Luebeck, Germany</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Schillaci</surname><given-names>Giuseppe</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>University of Perugia, Italy</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>jockel_y@klinik.uni-wuerzburg.de</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: YJ I. Harks I. Haubitz SF ME US JB. Performed the experiments: YJ JB. Analyzed the data: YJ I. Harks I. Haubitz SF ME US JB. Contributed reagents/materials/analysis tools: YJ I. Harks ME US JB. Contributed to the writing of the manuscript: YJ I. Harks I. Haubitz ME US JB.</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>1</day><month>8</month><year>2014</year></pub-date><volume>9</volume><issue>8</issue><elocation-id>e103449</elocation-id><history><date date-type="received"><day>27</day><month>3</month><year>2014</year></date><date date-type="accepted"><day>30</day><month>6</month><year>2014</year></date></history><permissions><copyright-year>2014</copyright-year><copyright-holder>Jockel-Schneider et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Aim</title><p>This single blind cross-sectional study compared the vascular health of subjects suffering from severe chronic periodontitis, severe aggressive periodontitis and periodontal healthy controls by evaluating pulse wave velocity (PWV), augmentation index (AIx) and pulse pressure amplification (PPA).</p></sec><sec><title>Material and Methods</title><p>In a total of 158 subjects, 92 suffering from severe periodontitis and 66 matched periodontal healthy controls, PWV, AIx, central and peripheral blood pressure were recorded using an oscillometric device (Arteriograph).</p></sec><sec><title>Results</title><p>Subjects suffering from severe chronic or aggressive periodontitis exhibited significantly higher PWV (p = 0.00004), higher AIx (p = 0.0049) and lower PPA (p = 0.028) than matched periodontal healthy controls.</p></sec><sec><title>Conclusions</title><p>The results of this study confirm the association between periodontal inflammation and increased cardiovascular risk shown by impaired vascular health in case of severe periodontitis. As impaired vascular health is a common finding in patients suffering from severe periodontal disease a concomitant routine cardiovascular evaluation may be advised.</p></sec></abstract><funding-group><funding-statement>This study was funded externally by a grant of the German Research Foundation (EH 365/1-1) and by the IZKF Wuerzburg (Z-2/34). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="8"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.</p></notes></front><body><sec id="s1"><title>Introduction</title><p>The association between oral inflammation and the risk for myocardial infarction or stroke has been firstly described already more than two decades ago <xref rid="pone.0103449-Mattila1" ref-type="bibr">[1]</xref>, <xref rid="pone.0103449-Syrjanen1" ref-type="bibr">[2]</xref>. Ever since, a steadily increasing number of studies and reviews have firmly established a positive association between atherosclerosis and periodontal inflammation <xref rid="pone.0103449-Humphrey1" ref-type="bibr">[3]</xref>–<xref rid="pone.0103449-Kebschull1" ref-type="bibr">[5]</xref>. Preliminary intervention studies were able to prove the positive influence of various periodontal therapeutic measures on endothelial dysfunction, e.g. sub- and supragingival debridement <xref rid="pone.0103449-Elter1" ref-type="bibr">[6]</xref>, <xref rid="pone.0103449-Mercanoglu1" ref-type="bibr">[7]</xref>, debridement supplemented by systemic antibiotics <xref rid="pone.0103449-Seinost1" ref-type="bibr">[8]</xref> or debridement in conjunction with local antibiotics <xref rid="pone.0103449-Tonetti1" ref-type="bibr">[9]</xref>. For the evaluation of endothelial dysfunction, the first measurable stage of developing atherosclerosis, in these studies usually the flow-mediated dilatation FMD (endothelium-dependent) or the nitroglycerin-mediated dilatation (endothelium-independent) of the brachial artery, have been recorded. While the validity of data obtained by FMD and nitro-glycerine-mediated dilatation has been verified by various trials, both methods require a very high level of examiner training to avoid faulty measurements and are time-consuming and expensive. Therefore the need for less expensive and clinically less demanding alternatives for routine vascular recording lead to the re-evaluation of the well-established principle of pulse wave velocity (PWV), augmentation index (AIx) and central pressures as clinically highly relevant indicators of vascular health.</p><p>The measurement of arterial stiffness by pulse wave reflection may be regarded as a prognostic significant extension of conventional vascular diagnosis. PWV is a direct marker of arterial stiffness <xref rid="pone.0103449-Ferrari1" ref-type="bibr">[10]</xref>, <xref rid="pone.0103449-Safar1" ref-type="bibr">[11]</xref>. Increased PWV is a strong predictor for future cardiovascular events and mortality in patients with and without diverse risk factors, as for example end-stage renal disease <xref rid="pone.0103449-Blacher1" ref-type="bibr">[12]</xref>, patients with type 2 diabetes <xref rid="pone.0103449-Cruickshank1" ref-type="bibr">[13]</xref> hypertension <xref rid="pone.0103449-Boutouyrie1" ref-type="bibr">[14]</xref>, elderly people <xref rid="pone.0103449-Meaume1" ref-type="bibr">[15]</xref> or the general population <xref rid="pone.0103449-Mitchell1" ref-type="bibr">[16]</xref>–<xref rid="pone.0103449-WillumHansen1" ref-type="bibr">[18]</xref>.</p><p>An indirect measure of arterial stiffness and a direct measure of pulse wave reflection is the augmentation pressure and the augmentation index <xref rid="pone.0103449-Baulmann1" ref-type="bibr">[19]</xref>. Augmentation can be described as the effect of wave reflection on the aortic systolic pressure peak. Accordingly, augmentation is a measure for the additional pressure caused by pulse wave reflection stressing the left ventricle <xref rid="pone.0103449-ORourke1" ref-type="bibr">[20]</xref>. AIx may be calculated by dividing the augmentation pressure by the pulse pressure. In principle, the AIx may be obtained by calculating the quotient of the pressure peak of the initial and the reflected wave (<xref ref-type="fig" rid="pone-0103449-g001">Fig. 1</xref><xref rid="pone.0103449-Baulmann1" ref-type="bibr">[19]</xref>. All parameters influencing the AIx subsequently also have an impact on the central blood pressure. The measurement of the pulse wave reflection therefore allows an estimation of the central blood pressure, and may differ substantially from the recordable peripheral blood pressure <xref rid="pone.0103449-Baulmann1" ref-type="bibr">[19]</xref>. It correlates well with left ventricular mass in hypertensive and in normotensive young men <xref rid="pone.0103449-Marchais1" ref-type="bibr">[21]</xref> and is an independent marker for premature coronary artery disease <xref rid="pone.0103449-Weber1" ref-type="bibr">[22]</xref>. In different populations e.g. patients with end-stage renal failure, the AIx is also an independent predictor of mortality <xref rid="pone.0103449-London1" ref-type="bibr">[23]</xref>.</p><fig id="pone-0103449-g001" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journalone.0103449.g001</object-id><label>Figure 1</label><caption><title>Original recording of an oscillometrically generated pulse wave (modified by Baulmann et al. 2008).</title></caption><graphic xlink:href="pone.0103449.g001"></graphic></fig><p>Both, PWV and AIx, provide essential information on the status of the arterial vascular system. The prognostic significance of arterial stiffness is very high. Measurements of PWV and AIx calculations allow stratifying patients with a high risk profile for cardiac and cerebral events who might benefit from more intensive cardiovascular treatment schemes <xref rid="pone.0103449-Baulmann1" ref-type="bibr">[19]</xref>.</p><p>Recently a new recording system for the assessment of vascular function on the basis of recorded pulse wave data has been developed, the so called Arteriograph. The Arteriograph was the very first validated device that allowed the measurement of PWV, AIx and central pressures by analysis of the oscillometric pressure curves registered on the upper arm with a single pressure cuff <xref rid="pone.0103449-Baulmann2" ref-type="bibr">[24]</xref>. The principle of the oscillometric method is based on plethysmography and registers oscillometric pulsatile pressure changes in the brachial artery. Pressure fluctuations in the brachial artery are revealed by a pressure sensor in the cuff passing the recorded data to a computer for further analysis and computation of pulse pressure waves (<xref ref-type="fig" rid="pone-0103449-g001">Fig. 1</xref>). PWV is calculated in m/s for a given patient by relating the recorded time difference (ms) between the onset of the first pulse wave and the onset of the reflected pulse wave to the measured distance between the jugulum and the symphysis. The AIx corresponds to the pressure difference (amplitude difference; P1–P2, <xref ref-type="fig" rid="pone-0103449-g001">Fig. 1</xref>) between the first and second wave in relation to the pulse pressure (PP). The Arteriograph calculates the AIx based on a fixed formula and thus provides the aortic AIx without applying a transfer function <xref rid="pone.0103449-Baulmann2" ref-type="bibr">[24]</xref>.</p><sec id="s1a"><title>Aim</title><p>The aim of this cross sectional study was to assess the cardiovascular status of patients suffering from severe aggressive or chronic periodontitis by recording pulse wave velocity, augmentation index and central blood pressure with the Arteriograph and compare it to data recorded from matched periodontal healthy controls.</p></sec></sec><sec sec-type="materials|methods" id="s2"><title>Materials and Methods</title><sec id="s2a"><title>Study design</title><p>This investigation was designed as a single blind cross-sectional trial. The study protocol, prepared in accordance with the declaration of Helsinki of 1973 and meeting the GCP criteria, was approved by the ethics committee of the University of Wuerzburg. All subjects included have signed the informed consent. A positive vote of the ethics committee of the University of Wuerzburg from 2009 (file #39-09) is easily available (e.g. on request via mail to the corresponding author).</p></sec><sec id="s2b"><title>Study setting</title><p>Study subjects were screened and recruited from individuals seeking dental care at the School of Dental Medicine of the University of Wuerzburg.</p></sec><sec id="s2c"><title>Inclusion criteria</title><p>Patients suffering from untreated severe generalised chronic or aggressive periodontitis were eligible for participation in test group. The diagnosis of generalised severe chronic or aggressive periodontitis was based on the classification criteria of the International Workshop for a Classification of Periodontal Diseases and Conditions <xref rid="pone.0103449-Armitage1" ref-type="bibr">[25]</xref>.</p><p>The severity of disease expression was categorized according to the proposal of the working group of the Centers for Disease Control (CDC) and the American Academy of Periodontology (AAP) <xref rid="pone.0103449-Page1" ref-type="bibr">[26]</xref>.</p><p>In order to restrict inclusion only to subjects with extensive periodontal lesions study patients additionally had to meet the following criteria: Patients with clinical detectable attachment loss ≥6 mm in a minimum of two different sextants and a minimum of six interproximal sites on six different teeth were eligible for inclusion in the test group.</p><p>Individuals exhibiting minor periodontal pockets ≤3 mm were designated periodontal healthy and were eligible for inclusion in the control group.</p></sec><sec id="s2d"><title>Exclusion criteria</title><p>Individuals meeting the following criteria were not eligible for study participation: Less than ten natural teeth, age <18 years, pregnancy or breastfeeding, infectious disease, systematic periodontal therapy within the last five years, antibiotic medication within the last six months, intellectual inability to fully comprehend the aims of the study, severely decayed teeth, atrial fibrillation, or severe cardiac valve vitium.</p></sec><sec id="s2e"><title>Screening, recruitment and examination</title><p>A total of 724 subjects were screened, 256 met the inclusion criteria. Ultimately 158 subjects (75 male/83 female) were enrolled in the study. 92 patients were assigned to the test group (severe periodontitis). 74 received the diagnosis of severe chronic periodontitis and 18 suffered from aggressive periodontitis. 66 subjects served as periodontally healthy controls. Individuals meeting the inclusion criteria after the screening examination were informed about the aims of the study and asked for their participation. All patients who participated in the study signed informed consent and received an assessment of their periodontal health by recording a comprehensive periodontal status as well as an assessment of their cardiovascular status by using the Arteriograph within the next seven days. For matching purposes furthermore age, gender, weight, height, smoking habits and the presence of known systemic medical problems (e.g. diabetes) were recorded using a questionnaire.</p></sec><sec id="s2f"><title>Background factors</title><p>After setting the age of the evaluated subjects to older than 35 years it was not necessary to match the patients in the sense of pair wise assignment. The limit of 35 years was chosen because in the periodontitis group no one was younger than 36. After this exclusion, except the peripheral pulse pressure, there were no significant differences between the periodontally healthy controls and the test group suffering from severe periodontal diseases regarding the following parameters: gender, age, body mass index, height, weight, smoking habits, arterial hypertension, and presence of hypercholesterolemia. The same holds true for medication (<xref ref-type="table" rid="pone-0103449-t001">tables 1</xref> and <xref ref-type="table" rid="pone-0103449-t002">2</xref>).</p><table-wrap id="pone-0103449-t001" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journalone.0103449.t001</object-id><label>Table 1</label><caption><title>Clinical characteristics of the studied population.</title></caption><alternatives><graphic id="pone-0103449-t001-1" xlink:href="pone.0103449.t001"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col></colgroup><thead><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td colspan="3" align="left" rowspan="1">Group</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Unit</td><td align="left" rowspan="1" colspan="1">no/mild periodontitis</td><td align="left" rowspan="1" colspan="1">severe chronic/aggressive periodontitis</td><td align="left" rowspan="1" colspan="1">P</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">n = 66</td><td align="left" rowspan="1" colspan="1">n = 92</td><td align="left" rowspan="1" colspan="1"></td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Age</td><td align="left" rowspan="1" colspan="1">years</td><td align="left" rowspan="1" colspan="1">55±13</td><td align="left" rowspan="1" colspan="1">55±10</td><td align="left" rowspan="1" colspan="1">0.71</td></tr><tr><td align="left" rowspan="1" colspan="1">BMI</td><td align="left" rowspan="1" colspan="1">kg/m<sup>2</sup></td><td align="left" rowspan="1" colspan="1">25±4</td><td align="left" rowspan="1" colspan="1">26±3</td><td align="left" rowspan="1" colspan="1">0.60</td></tr><tr><td align="left" rowspan="1" colspan="1">Male gender</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">43,9</td><td align="left" rowspan="1" colspan="1">50,0</td><td align="left" rowspan="1" colspan="1">0.45</td></tr><tr><td align="left" rowspan="1" colspan="1">Smoker</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">30,3</td><td align="left" rowspan="1" colspan="1">21,7</td><td align="left" rowspan="1" colspan="1">0.22</td></tr><tr><td align="left" rowspan="1" colspan="1">Hypertension</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">17.2</td><td align="left" rowspan="1" colspan="1">22.5</td><td align="left" rowspan="1" colspan="1">0.44</td></tr><tr><td align="left" rowspan="1" colspan="1">Hypercholesteremia</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">10.0</td><td align="left" rowspan="1" colspan="1">10.9</td><td align="left" rowspan="1" colspan="1">1.0</td></tr></tbody></table></alternatives><table-wrap-foot><fn id="nt101"><label></label><p>Values are expressed as mean ± SD as a result of Mann-Whitney U-Test for age and BMI or in % as a result of Chi-squared for the others.</p></fn></table-wrap-foot></table-wrap><table-wrap id="pone-0103449-t002" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journalone.0103449.t002</object-id><label>Table 2</label><caption><title>Medication of the studied population.</title></caption><alternatives><graphic id="pone-0103449-t002-2" xlink:href="pone.0103449.t002"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col></colgroup><thead><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td colspan="3" align="left" rowspan="1">Group</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Unit</td><td align="left" rowspan="1" colspan="1">no/mild periodontitis</td><td align="left" rowspan="1" colspan="1">severe chronic/aggressive periodontitis</td><td align="left" rowspan="1" colspan="1">P</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">n = 66</td><td align="left" rowspan="1" colspan="1">n = 91</td><td align="left" rowspan="1" colspan="1"></td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Diuretics (treated)</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1">3.3</td><td align="left" rowspan="1" colspan="1">0.29</td></tr><tr><td align="left" rowspan="1" colspan="1">Statins (treated)</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">8.8</td><td align="left" rowspan="1" colspan="1">12.0</td><td align="left" rowspan="1" colspan="1">0.54</td></tr><tr><td align="left" rowspan="1" colspan="1">β-Blockers (treated)</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">7.0</td><td align="left" rowspan="1" colspan="1">16.3</td><td align="left" rowspan="1" colspan="1">0.086</td></tr><tr><td align="left" rowspan="1" colspan="1">Calcium channel blockers (treated)</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">3.5</td><td align="left" rowspan="1" colspan="1">3.3</td><td align="left" rowspan="1" colspan="1">1.0</td></tr><tr><td align="left" rowspan="1" colspan="1">NSAID (treated)</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">17.5</td><td align="left" rowspan="1" colspan="1">14.1</td><td align="left" rowspan="1" colspan="1">0.58</td></tr><tr><td align="left" rowspan="1" colspan="1">ACE-inhibitors (treated)</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">8.8</td><td align="left" rowspan="1" colspan="1">15.2</td><td align="left" rowspan="1" colspan="1">0.24</td></tr></tbody></table></alternatives><table-wrap-foot><fn id="nt102"><label></label><p>Values are expressed in % as result of Chi-squared test. NSAID = non-steroidal anti-inflammatory drugs; ACE = angiotensin converting enzyme.</p></fn></table-wrap-foot></table-wrap></sec><sec id="s2g"><title>Periodontal examination</title><p>The periodontal examination comprised the following parameters: Number of intraoral visible teeth, pocket probing depth (PPD) and clinical attachment level (CAL). Measurements were performed at six sites per tooth using a CP-12 Marquis periodontal probe (Hu Friedy Co., USA); Recorded measurements were rounded to the nearest millimeter. All periodontal examinations were executed by a single clinically experienced dentist. To ensure the reproducibility of the clinical test results, an intra-individual calibration was performed. For this, 4 phantom models with periodontal defects with each 27 teeth were measured at two points in time. The examiner was calibrated if the first measurement and the measurement 48 hours later was were equal at 75% of the measurements with total agreement and 95% within±1 mm <xref rid="pone.0103449-Grossi1" ref-type="bibr">[27]</xref>.</p></sec><sec id="s2h"><title>Vascular examination</title><p>After the periodontal examination the recording of the cardiovascular parameters was performed during a subsequent appointment within the next seven days using the Arteriograph (TensioMed Ltd, Hungary) with the corresponding TensioMed analysis software (version 1.9.9.12).</p><p>In accordance with the international guidelines for the implementation of arterial stiffness measurements, all measurements were made in the same room under quiet conditions and dim illumination, unaffected by external environmental influences <xref rid="pone.0103449-VanBortel1" ref-type="bibr">[28]</xref>.</p><p>Firstly the distance between the sternal notch (jugulum) and the symphysis was recorded with a tape measure. Subsequently, in order to minimize sources of recording error each patient had a rest period of ten minutes before the onset of the cardiovascular measurements. All measurements were performed three times, with a predetermined free interval of two minutes between the individual measuring periods. During the examination the study subjects lay relaxed on an examination couch with eyes closed. All vascular data were recorded by the same trained medical technical assistant who was unaware of the assignment of the study subjects to the test or control group.</p><p>The analysis of the Arteriograph data was performed by an experienced cardiologist (JB) who also was unaware of the assignment of the data to the different groups.</p></sec><sec id="s2i"><title>Statistical analysis</title><p>Statistical data analysis was performed by a professional statistician using the WinMEDAS (C. Grund, Germany) statistical software package.</p><p>To calculate the differences between both groups the Mann-Whitney U-test was used for continuous variables. The Chi-square-test or Fishers test for expected values below 5 was used for nominal scale data. The level of significance was set to p<0.05.</p></sec></sec><sec id="s3"><title>Results</title><sec id="s3a"><title>1. Pulse Wave Velocity (PWV)</title><p>The results of the PWV data analysis are depicted in <xref ref-type="fig" rid="pone-0103449-g002">figure 2</xref>. Data evaluation revealed significantly higher PWV values for patients suffering from severe chronic periodontitis or severe aggressive periodontitis when compared to the periodontal healthy controls (p = 0.00004).</p><fig id="pone-0103449-g002" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journalone.0103449.g002</object-id><label>Figure 2</label><caption><title>Pulse wave velocity (PWV) data recorded for the 2 experimental groups.</title></caption><graphic xlink:href="pone.0103449.g002"></graphic></fig></sec><sec id="s3b"><title>2. Aortic Augmentation Index (AIx)</title><p>The results of the calculation of the AIx data for the test and control group are shown in <xref ref-type="fig" rid="pone-0103449-g003">figure 3</xref>. AIx scores calculated for the periodontally healthy individuals of the control group proved to be significantly lower (p = 0.0049) than the AIx scores calculated for those with severe aggressive periodontitis or severe chronic periodontitis.</p><fig id="pone-0103449-g003" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journalone.0103449.g003</object-id><label>Figure 3</label><caption><title>Aortic Augmentation Index (AIx) data calculated for the 2 experimental groups.</title></caption><graphic xlink:href="pone.0103449.g003"></graphic></fig></sec><sec id="s3c"><title>3. Pulse pressure amplification (PPA) and central pressure</title><p>In the periodontally healthy controls the peripheral diastolic blood pressure was lower, peripheral systolic blood pressure higher and consequently the peripheral pulse pressure significantly higher (p = 0.0024) than the values recorded for the periodontitis group (see <xref ref-type="table" rid="pone-0103449-t003">table 3</xref>). However when central pulse pressures were compared the differences disappeared, indicating that the pulse pressure and thus the central pressure is higher and pulse pressure amplification lower in the periodontitis group when compared to the healthy controls (p = 0.028 for PPA, <xref ref-type="table" rid="pone-0103449-t004">table 4</xref>). The observed central augmentation pressure shows the tendency to be higher in the periodontitis group (p = 0.064, <xref ref-type="table" rid="pone-0103449-t004">table 4</xref>).</p><table-wrap id="pone-0103449-t003" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journalone.0103449.t003</object-id><label>Table 3</label><caption><title>Hemodynamic characteristics of the studied population.</title></caption><alternatives><graphic id="pone-0103449-t003-3" xlink:href="pone.0103449.t003"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col></colgroup><thead><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td colspan="3" align="left" rowspan="1">Group</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Unit</td><td align="left" rowspan="1" colspan="1">no/mild periodontitis</td><td align="left" rowspan="1" colspan="1">severe chronic/aggressive periodontitis</td><td align="left" rowspan="1" colspan="1">P</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">n = 66</td><td align="left" rowspan="1" colspan="1">n = 92</td><td align="left" rowspan="1" colspan="1"></td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Heart rate</td><td align="left" rowspan="1" colspan="1">bpm</td><td align="left" rowspan="1" colspan="1">69±10</td><td align="left" rowspan="1" colspan="1">67±10</td><td align="left" rowspan="1" colspan="1">0.089</td></tr><tr><td align="left" rowspan="1" colspan="1">Peripheral systolic blood pressure</td><td align="left" rowspan="1" colspan="1">mmHg</td><td align="left" rowspan="1" colspan="1">134±21</td><td align="left" rowspan="1" colspan="1">129±16</td><td align="left" rowspan="1" colspan="1">0.18</td></tr><tr><td align="left" rowspan="1" colspan="1">Peripheral diastolic blood pressure</td><td align="left" rowspan="1" colspan="1">mmHg</td><td align="left" rowspan="1" colspan="1">80±11</td><td align="left" rowspan="1" colspan="1">82±10</td><td align="left" rowspan="1" colspan="1">0.89</td></tr><tr><td align="left" rowspan="1" colspan="1">Peripheral pulse pressure</td><td align="left" rowspan="1" colspan="1">mmHg</td><td align="left" rowspan="1" colspan="1">54±14</td><td align="left" rowspan="1" colspan="1">47±10</td><td align="left" rowspan="1" colspan="1">0.0024**</td></tr></tbody></table></alternatives><table-wrap-foot><fn id="nt103"><label></label><p>Values are expressed as mean ± SD as a result of Mann-Whitney U-Test.</p></fn></table-wrap-foot></table-wrap><table-wrap id="pone-0103449-t004" orientation="portrait" position="float"><object-id pub-id-type="doi">10.1371/journalone.0103449.t004</object-id><label>Table 4</label><caption><title>Stiffness- and pulse wave reflection related hemodynamics of the studied population.</title></caption><alternatives><graphic id="pone-0103449-t004-4" xlink:href="pone.0103449.t004"></graphic><table frame="hsides" rules="groups"><colgroup span="1"><col align="left" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col><col align="center" span="1"></col></colgroup><thead><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td colspan="3" align="left" rowspan="1">Group</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">Unit</td><td align="left" rowspan="1" colspan="1">no/mild periodontitis</td><td align="left" rowspan="1" colspan="1">severe chronic/aggressive periodontitis</td><td align="left" rowspan="1" colspan="1">P</td></tr><tr><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">n = 66</td><td align="left" rowspan="1" colspan="1">n = 91</td><td align="left" rowspan="1" colspan="1"></td></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Central systolic blood pressure</td><td align="left" rowspan="1" colspan="1">mmHg</td><td align="left" rowspan="1" colspan="1">125.9±22.9</td><td align="left" rowspan="1" colspan="1">124.3±17.8</td><td align="left" rowspan="1" colspan="1">0.87</td></tr><tr><td align="left" rowspan="1" colspan="1">Central pulse pressure</td><td align="left" rowspan="1" colspan="1">mmHg</td><td align="left" rowspan="1" colspan="1">46.2±16.3</td><td align="left" rowspan="1" colspan="1">42.1±11.3</td><td align="left" rowspan="1" colspan="1">0.15</td></tr><tr><td align="left" rowspan="1" colspan="1">Pulse pressure amplification</td><td align="left" rowspan="1" colspan="1"></td><td align="left" rowspan="1" colspan="1">1.2±0.2</td><td align="left" rowspan="1" colspan="1">1.1±0.1</td><td align="left" rowspan="1" colspan="1">0.028*</td></tr><tr><td align="left" rowspan="1" colspan="1">Aortic augmentation index (AIx)</td><td align="left" rowspan="1" colspan="1">%</td><td align="left" rowspan="1" colspan="1">19.1±10.6</td><td align="left" rowspan="1" colspan="1">23.7±8.3</td><td align="left" rowspan="1" colspan="1">0.0049**</td></tr><tr><td align="left" rowspan="1" colspan="1">Augmentation pressure</td><td align="left" rowspan="1" colspan="1">mmHg</td><td align="left" rowspan="1" colspan="1">9.9±8.8</td><td align="left" rowspan="1" colspan="1">10.4±5.8</td><td align="left" rowspan="1" colspan="1">0.064</td></tr><tr><td align="left" rowspan="1" colspan="1">Pulse wavevelocity (PWV)</td><td align="left" rowspan="1" colspan="1">m/s</td><td align="left" rowspan="1" colspan="1">7.7±1.9</td><td align="left" rowspan="1" colspan="1">9.1±2.2</td><td align="left" rowspan="1" colspan="1">0.00004***</td></tr></tbody></table></alternatives><table-wrap-foot><fn id="nt104"><label></label><p>Values are expressed as mean ± SD as a result of Mann-Whitney U-Test.</p></fn></table-wrap-foot></table-wrap></sec></sec><sec id="s4"><title>Discussion</title><p>The main finding of this study is that in patients suffering from severe chronic or aggressive periodontitis arterial stiffness and pulse wave reflection are significantly increased.</p><p>It further supports the evidence for an association between periodontal and cardiovascular health and is in line with the data of several other studies <xref rid="pone.0103449-Mattila1" ref-type="bibr">[1]</xref>, <xref rid="pone.0103449-Briggs1" ref-type="bibr">[29]</xref>–<xref rid="pone.0103449-Tonetti2" ref-type="bibr">[32]</xref>.</p><p>The specific relationship between arterial stiffness and periodontitis was documented only once before in a subgroup of patients suffering from arterial hypertension <xref rid="pone.0103449-Franek1" ref-type="bibr">[33]</xref>. The data of that study failed to prove a difference in PWV. They revealed a significantly higher left ventricular hypertrophy and significant differences in pulse wave reflection including increased central aortic pressures and increased augmentation in the periodontal disease group in the situation of arterial hypertension. A correlation between the pulse wave velocity and oral inflammation was, by contrast to our data, not confirmed. In terms of pulse wave reflection the results are in concordance with the findings of this study. We were able to identify higher AIx scores in the study subjects suffering from severe periodontal disease when compared to the periodontally healthy controls. Besides a higher sample rate in our study the main difference between Franek’s and our study is patient selection. As in many other studies the study by Franek et al. 2009 evaluated a highly selected population. Only patients with hypertension were included in their trial. Other studies have shown that hypertensive patients themselves display higher pulse wave velocity scores than patients with normal blood pressure <xref rid="pone.0103449-Boutouyrie1" ref-type="bibr">[14]</xref>, <xref rid="pone.0103449-Sigurdsson1" ref-type="bibr">[34]</xref>. That may be one reason for the diverging study results. Differences induced by hypertension might have superimposed changes caused by periodontal inflammation. Whereas Franek focused on a subgroup of hypertension we included a wide range of cardiovascular compromised as well as cardiovascular healthy subjects. The higher number of evaluated individuals (n = 724) in the present study allowed for a meaningful statistical analysis.</p><p>Nevertheless, data analysis revealed that the mean peripheral blood pressure of both groups is within the normal range (≤140 systolic, and ≤90 diastolic). On the basis of a routine peripheral blood pressure control by the method of Riva-Rocci, the average individual in the test group would have been classified as patient with no risk factor for cardiovascular events. This illustrates the potential benefits of the oscillometric pulse wave analysis (e.g. Arteriograph) compared to ordinary blood pressure measurements for the detection of early or preclinical signs of cardiovascular dysfunction.</p><p>Another point to discuss is the diagnosis and thus the grouping of the patients. The use of the established Community Periodontal Index of Treatment Needs CPITN <xref rid="pone.0103449-Ainamo1" ref-type="bibr">[35]</xref>, for classifying the severity of periodontal disease as done in many previous investigations including the study by Franek et al. should be questioned critically. The scoring system of the CPITN tends to overestimate the severity of periodontal disease expression <xref rid="pone.0103449-Mattila1" ref-type="bibr">[1]</xref>, <xref rid="pone.0103449-Micheelis1" ref-type="bibr">[36]</xref>. For this reason, in all study participants we recorded a comprehensive periodontal status and the severity of disease expression was classified following the proposal of the working group of the Centers for Disease Control (CDC) and the American Academy of Periodontology (AAP) <xref rid="pone.0103449-Page1" ref-type="bibr">[26]</xref>. To ensure the inclusion of individuals with a substantial inflammatory burden in the periodontitis group, only subjects with a minimum of six teeth displaying pockets depth ≥6 mm were recruited, which is also in contrast to the disease severity of patients evaluated in other preceding investigations.</p><p>Particularly in young individuals with a diagnosis of aggressive periodontitis the recorded pulse wave velocity values were significantly higher than those found in the periodontally healthy controls (data not shown). This is consistent with findings from other studies documenting a much stronger association between periodontal infections and vascular endpoints in younger patients <xref rid="pone.0103449-Dietrich1" ref-type="bibr">[37]</xref>, <xref rid="pone.0103449-Jimenez1" ref-type="bibr">[38]</xref>. By which mechanisms the observed vascular changes are correlated with the manifestation of severe periodontal disease may not be answered by the present data.</p><p>“Translating” the arterial stiffness measurements observed in this study into a biological vascular age may serve as an illustration for the importance of the present findings <xref rid="pone.0103449-McEniery1" ref-type="bibr">[39]</xref>. For this purpose, the results of the present study are compared to standard values obtained from measurements made in the healthy general population. Patients with aggressive periodontitis or severe chronic periodontitis, displaying an average pulse wave velocity of 9.1 m/s their biological vascular age is about 20 years higher than that of the healthy age-corrected group and therefore pre-aged to a huge extent. Even more dramatic are is the interpretation of the results in terms of mortality and the incidence of cardiovascular events. An increase in pulse wave velocity of 1 m/s implies an estimated 14% increased risk for cardiovascular events, and a 15% increased risk for overall mortality rate accordingly to mortality rates of Vlachopoulos’ review <xref rid="pone.0103449-Vlachopoulos1" ref-type="bibr">[17]</xref>.</p><p>For the prediction of cardiovascular events the central pressure is more important than the peripheral <xref rid="pone.0103449-Roman1" ref-type="bibr">[40]</xref>. Again, the present study revealed that periodontitis patients exhibit significantly higher central pressures (expressed as PPA) than periodontal healthy controls reflecting the higher cardiovascular risk of the periodontitis patients. Increased PWV as marker of stiffening of the large arteries suggest that periodontitis patients suffer from a broad range of subclinical vasculature dysfunction.</p><p>The most frequently cited reason for the intake of beta-blocker is the diagnosis “hypertension”. Beta-blockers per se (possible exception nebivolol) affect arterial stiffness possibly indirectly by lowering of peripheral blood pressure and/or the initially ejected pressure wave without changing central hemodynamics. Though beta-blockers are known to lower PWV the group with the more frequent intake of β-blockers is showing higher PWV (the periodontitis group). One might speculate that if the intake of beta-blockers would be completely uniformly distributed, the difference in PWV of the groups could even be more pronounced. The same holds true for PPA. Nevertheless both, the intake of beta-blockers and the diagnosis hypertension, are not significantly different in both groups.</p><p>This cross-sectional study shows for the first time a pathophysiological and highly significant predictive risk marker of PWV in addition to the above described pulse wave reflection to be higher in patients suffering from severe periodontitis. Further intervention studies using these markers of vascular dysfunction and vascular structure as endpoints may be required to elucidate possible causal relationships between periodontal and cardiovascular disease.</p></sec></body><back><ref-list><title>References</title><ref id="pone.0103449-Mattila1"><label>1</label><mixed-citation publication-type="journal"><name><surname>Mattila</surname><given-names>KJ</given-names></name>, <name><surname>Nieminen</surname><given-names>MS</given-names></name>, <name><surname>Valtonen</surname><given-names>VV</given-names></name>, <name><surname>Rasi</surname><given-names>VP</given-names></name>, <name><surname>Kesaniemi</surname><given-names>YA</given-names></name>, <etal>et al</etal> (<year>1989</year>) <article-title>Association between dental health and acute myocardial infarction</article-title>. <source>BMJ</source><volume>298</volume>: <fpage>779</fpage>–<lpage>781</lpage>.<pub-id pub-id-type="pmid">2496855</pub-id></mixed-citation></ref><ref id="pone.0103449-Syrjanen1"><label>2</label><mixed-citation publication-type="journal"><name><surname>Syrjanen</surname><given-names>J</given-names></name>, <name><surname>Peltola</surname><given-names>J</given-names></name>, <name><surname>Valtonen</surname><given-names>V</given-names></name>, <name><surname>Iivanainen</surname><given-names>M</given-names></name>, <name><surname>Kaste</surname><given-names>M</given-names></name>, <etal>et al</etal> (<year>1989</year>) <article-title>Dental infections in association with cerebral infarction in young and middle-aged men</article-title>. <source>J Intern Med</source><volume>225</volume>: <fpage>179</fpage>–<lpage>184</lpage>.<pub-id pub-id-type="pmid">2703800</pub-id></mixed-citation></ref><ref id="pone.0103449-Humphrey1"><label>3</label><mixed-citation publication-type="journal"><name><surname>Humphrey</surname><given-names>LL</given-names></name>, <name><surname>Fu</surname><given-names>R</given-names></name>, <name><surname>Buckley</surname><given-names>DI</given-names></name>, <name><surname>Freeman</surname><given-names>M</given-names></name>, <name><surname>Helfand</surname><given-names>M</given-names></name> (<year>2008</year>) <article-title>Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis</article-title>. <source>J Gen Intern Med</source><volume>23</volume>: <fpage>2079</fpage>–<lpage>2086</lpage><comment><ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1007/s11606-008-0787-6">10.1007/s11606-008-0787-6</ext-link> [doi]</comment><pub-id pub-id-type="pmid">18807098</pub-id></mixed-citation></ref><ref id="pone.0103449-Janket1"><label>4</label><mixed-citation publication-type="journal"><name><surname>Janket</surname><given-names>SJ</given-names></name>, <name><surname>Baird</surname><given-names>AE</given-names></name>, <name><surname>Chuang</surname><given-names>SK</given-names></name>, <name><surname>Jones</surname><given-names>JA</given-names></name> (<year>2003</year>) <article-title>Meta-analysis of periodontal disease and risk of coronary heart disease and stroke</article-title>. <source>Oral Surg Oral Med Oral Pathol Oral Radiol Endod</source><volume>95</volume>: <fpage>559</fpage>–<lpage>569</lpage><comment>10.1067/moe.2003.107 [doi];S1079210402917075 [pii]</comment><pub-id pub-id-type="pmid">12738947</pub-id></mixed-citation></ref><ref id="pone.0103449-Kebschull1"><label>5</label><mixed-citation publication-type="journal"><name><surname>Kebschull</surname><given-names>M</given-names></name>, <name><surname>Demmer</surname><given-names>RT</given-names></name>, <name><surname>Papapanou</surname><given-names>PN</given-names></name> (<year>2010</year>) <article-title>“Gum bug, leave my heart alone!”–epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis</article-title>. <source>J Dent Res</source><volume>89</volume>: <fpage>879</fpage>–<lpage>902</lpage><comment>0022034510375281 [pii];10.1177/0022034510375281 [doi]</comment><pub-id pub-id-type="pmid">20639510</pub-id></mixed-citation></ref><ref id="pone.0103449-Elter1"><label>6</label><mixed-citation publication-type="journal"><name><surname>Elter</surname><given-names>JR</given-names></name>, <name><surname>Hinderliter</surname><given-names>AL</given-names></name>, <name><surname>Offenbacher</surname><given-names>S</given-names></name>, <name><surname>Beck</surname><given-names>JD</given-names></name>, <name><surname>Caughey</surname><given-names>M</given-names></name>, <etal>et al</etal> (<year>2006</year>) <article-title>The effects of periodontal therapy on vascular endothelial function: a pilot trial</article-title>. <source>Am Heart J</source><volume>151</volume>: <fpage>47</fpage><comment>S0002-8703(05)00901-4 [pii];10.1016/j.ahj.2005.10.002 [doi]</comment><pub-id pub-id-type="pmid">16368290</pub-id></mixed-citation></ref><ref id="pone.0103449-Mercanoglu1"><label>7</label><mixed-citation publication-type="journal"><name><surname>Mercanoglu</surname><given-names>F</given-names></name>, <name><surname>Oflaz</surname><given-names>H</given-names></name>, <name><surname>Oz</surname><given-names>O</given-names></name>, <name><surname>Gokbuget</surname><given-names>AY</given-names></name>, <name><surname>Genchellac</surname><given-names>H</given-names></name>, <etal>et al</etal> (<year>2004</year>) <article-title>Endothelial dysfunction in patients with chronic periodontitis and its improvement after initial periodontal therapy</article-title>. <source>J Periodontol</source><volume>75</volume>: <fpage>1694</fpage>–<lpage>1700</lpage><comment><ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1902/jop.2004.75.12.1694">10.1902/jop.2004.75.12.1694</ext-link> [doi]</comment><pub-id pub-id-type="pmid">15732873</pub-id></mixed-citation></ref><ref id="pone.0103449-Seinost1"><label>8</label><mixed-citation publication-type="journal"><name><surname>Seinost</surname><given-names>G</given-names></name>, <name><surname>Wimmer</surname><given-names>G</given-names></name>, <name><surname>Skerget</surname><given-names>M</given-names></name>, <name><surname>Thaller</surname><given-names>E</given-names></name>, <name><surname>Brodmann</surname><given-names>M</given-names></name>, <etal>et al</etal> (<year>2005</year>) <article-title>Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis</article-title>. <source>Am Heart J</source><volume>149</volume>: <fpage>1050</fpage>–<lpage>1054</lpage><comment>S0002870305000669 [pii];10.1016/j.ahj.2004.09.059 [doi]</comment><pub-id pub-id-type="pmid">15976787</pub-id></mixed-citation></ref><ref id="pone.0103449-Tonetti1"><label>9</label><mixed-citation publication-type="journal"><name><surname>Tonetti</surname><given-names>MS</given-names></name>, <name><surname>D'Aiuto</surname><given-names>F</given-names></name>, <name><surname>Nibali</surname><given-names>L</given-names></name>, <name><surname>Donald</surname><given-names>A</given-names></name>, <name><surname>Storry</surname><given-names>C</given-names></name>, <etal>et al</etal> (<year>2007</year>) <article-title>Treatment of periodontitis and endothelial function</article-title>. <source>N Engl J Med</source><volume>356</volume>: <fpage>911</fpage>–<lpage>920</lpage><comment>356/9/911 [pii];10.1056/NEJMoa063186 [doi]</comment><pub-id pub-id-type="pmid">17329698</pub-id></mixed-citation></ref><ref id="pone.0103449-Ferrari1"><label>10</label><mixed-citation publication-type="journal"><name><surname>Ferrari</surname><given-names>AU</given-names></name>, <name><surname>Radaelli</surname><given-names>A</given-names></name>, <name><surname>Centola</surname><given-names>M</given-names></name> (<year>2003</year>) <article-title>Invited review: aging and the cardiovascular system</article-title>. <source>J Appl Physiol</source><volume>95</volume>: <fpage>2591</fpage>–<lpage>2597</lpage><comment>10.1152/japplphysiol.00601.2003 [doi];95/6/2591 [pii]</comment><pub-id pub-id-type="pmid">14600164</pub-id></mixed-citation></ref><ref id="pone.0103449-Safar1"><label>11</label><mixed-citation publication-type="journal"><name><surname>Safar</surname><given-names>H</given-names></name>, <name><surname>Mourad</surname><given-names>JJ</given-names></name>, <name><surname>Safar</surname><given-names>M</given-names></name>, <name><surname>Blacher</surname><given-names>J</given-names></name> (<year>2002</year>) <article-title>Aortic pulse wave velocity, an independent marker of cardiovascular risk</article-title>. <source>Arch Mal Coeur Vaiss</source><volume>95</volume>: <fpage>1215</fpage>–<lpage>1218</lpage>.<pub-id pub-id-type="pmid">12611043</pub-id></mixed-citation></ref><ref id="pone.0103449-Blacher1"><label>12</label><mixed-citation publication-type="journal"><name><surname>Blacher</surname><given-names>J</given-names></name>, <name><surname>Guerin</surname><given-names>AP</given-names></name>, <name><surname>Pannier</surname><given-names>B</given-names></name>, <name><surname>Marchais</surname><given-names>SJ</given-names></name>, <name><surname>Safar</surname><given-names>ME</given-names></name>, <etal>et al</etal> (<year>1999</year>) <article-title>Impact of aortic stiffness on survival in end-stage renal disease</article-title>. <source>Circulation</source><volume>99</volume>: <fpage>2434</fpage>–<lpage>2439</lpage>.<pub-id pub-id-type="pmid">10318666</pub-id></mixed-citation></ref><ref id="pone.0103449-Cruickshank1"><label>13</label><mixed-citation publication-type="journal"><name><surname>Cruickshank</surname><given-names>K</given-names></name>, <name><surname>Riste</surname><given-names>L</given-names></name>, <name><surname>Anderson</surname><given-names>SG</given-names></name>, <name><surname>Wright</surname><given-names>JS</given-names></name>, <name><surname>Dunn</surname><given-names>G</given-names></name>, <etal>et al</etal> (<year>2002</year>) <article-title>Aortic pulse-wave velocity and its relationship to mortality in diabetes and glucose intolerance: an integrated index of vascular function</article-title>? <source>Circulation</source><volume>106</volume>: <fpage>2085</fpage>–<lpage>2090</lpage>.<pub-id pub-id-type="pmid">12379578</pub-id></mixed-citation></ref><ref id="pone.0103449-Boutouyrie1"><label>14</label><mixed-citation publication-type="journal"><name><surname>Boutouyrie</surname><given-names>P</given-names></name>, <name><surname>Tropeano</surname><given-names>AI</given-names></name>, <name><surname>Asmar</surname><given-names>R</given-names></name>, <name><surname>Gautier</surname><given-names>I</given-names></name>, <name><surname>Benetos</surname><given-names>A</given-names></name>, <etal>et al</etal> (<year>2002</year>) <article-title>Aortic stiffness is an independent predictor of primary coronary events in hypertensive patients: a longitudinal study</article-title>. <source>Hypertension</source><volume>39</volume>: <fpage>10</fpage>–<lpage>15</lpage>.<pub-id pub-id-type="pmid">11799071</pub-id></mixed-citation></ref><ref id="pone.0103449-Meaume1"><label>15</label><mixed-citation publication-type="journal"><name><surname>Meaume</surname><given-names>S</given-names></name>, <name><surname>Benetos</surname><given-names>A</given-names></name>, <name><surname>Henry</surname><given-names>OF</given-names></name>, <name><surname>Rudnichi</surname><given-names>A</given-names></name>, <name><surname>Safar</surname><given-names>ME</given-names></name> (<year>2001</year>) <article-title>Aortic pulse wave velocity predicts cardiovascular mortality in subjects >70 years of age</article-title>. <source>Arterioscler Thromb Vasc Biol</source><volume>21</volume>: <fpage>2046</fpage>–<lpage>2050</lpage>.<pub-id pub-id-type="pmid">11742883</pub-id></mixed-citation></ref><ref id="pone.0103449-Mitchell1"><label>16</label><mixed-citation publication-type="journal"><name><surname>Mitchell</surname><given-names>GF</given-names></name>, <name><surname>Hwang</surname><given-names>SJ</given-names></name>, <name><surname>Vasan</surname><given-names>RS</given-names></name>, <name><surname>Larson</surname><given-names>MG</given-names></name>, <name><surname>Pencina</surname><given-names>MJ</given-names></name>, <etal>et al</etal> (<year>2010</year>) <article-title>Arterial stiffness and cardiovascular events: the Framingham Heart Study</article-title>. <source>Circulation</source><volume>121</volume>: <fpage>505</fpage>–<lpage>511</lpage><comment>CIRCULATIONAHA.109.886655 [pii];10.1161/CIRCULATIONAHA.109.886655 [doi]</comment><pub-id pub-id-type="pmid">20083680</pub-id></mixed-citation></ref><ref id="pone.0103449-Vlachopoulos1"><label>17</label><mixed-citation publication-type="journal"><name><surname>Vlachopoulos</surname><given-names>C</given-names></name>, <name><surname>Aznaouridis</surname><given-names>K</given-names></name>, <name><surname>Stefanadis</surname><given-names>C</given-names></name> (<year>2010</year>) <article-title>Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis</article-title>. <source>J Am Coll Cardiol</source><volume>55</volume>: <fpage>1318</fpage>–<lpage>1327</lpage><comment>S0735-1097(10)00280-9 [pii];10.1016/j.jacc.2009.10.061 [doi]</comment><pub-id pub-id-type="pmid">20338492</pub-id></mixed-citation></ref><ref id="pone.0103449-WillumHansen1"><label>18</label><mixed-citation publication-type="journal"><name><surname>Willum-Hansen</surname><given-names>T</given-names></name>, <name><surname>Staessen</surname><given-names>JA</given-names></name>, <name><surname>Torp-Pedersen</surname><given-names>C</given-names></name>, <name><surname>Rasmussen</surname><given-names>S</given-names></name>, <name><surname>Thijs</surname><given-names>L</given-names></name>, <etal>et al</etal> (<year>2006</year>) <article-title>Prognostic value of aortic pulse wave velocity as index of arterial stiffness in the general population</article-title>. <source>Circulation</source><volume>113</volume>: <fpage>664</fpage>–<lpage>670</lpage><comment>113/5/664 [pii];10.1161/CIRCULATIONAHA.105.579342 [doi]</comment><pub-id pub-id-type="pmid">16461839</pub-id></mixed-citation></ref><ref id="pone.0103449-Baulmann1"><label>19</label><mixed-citation publication-type="journal"><name><surname>Baulmann</surname><given-names>J</given-names></name>, <name><surname>Nurnberger</surname><given-names>J</given-names></name>, <name><surname>Slany</surname><given-names>J</given-names></name>, <name><surname>Schmieder</surname><given-names>R</given-names></name>, <name><surname>Schmidt-Trucksass</surname><given-names>A</given-names></name>, <etal>et al</etal> (<year>2010</year>) <article-title>[Arterial stiffness and pulse wave analysis]</article-title>. <source>Dtsch Med Wochenschr</source><volume>135</volume> Suppl 1<fpage>S4</fpage>–<lpage>14</lpage><comment><ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1055/s-0030-1249183">10.1055/s-0030-1249183</ext-link> [doi]</comment><pub-id pub-id-type="pmid">20180172</pub-id></mixed-citation></ref><ref id="pone.0103449-ORourke1"><label>20</label><mixed-citation publication-type="other">O'Rourke MF (1999) Wave travel and reflection in the arterial system. J Hypertens Suppl 17: S45–S47.</mixed-citation></ref><ref id="pone.0103449-Marchais1"><label>21</label><mixed-citation publication-type="journal"><name><surname>Marchais</surname><given-names>SJ</given-names></name>, <name><surname>Guerin</surname><given-names>AP</given-names></name>, <name><surname>Pannier</surname><given-names>BM</given-names></name>, <name><surname>Levy</surname><given-names>BI</given-names></name>, <name><surname>Safar</surname><given-names>ME</given-names></name>, <etal>et al</etal> (<year>1993</year>) <article-title>Wave reflections and cardiac hypertrophy in chronic uremia. Influence of body size</article-title>. <source>Hypertension</source><volume>22</volume>: <fpage>876</fpage>–<lpage>883</lpage>.<pub-id pub-id-type="pmid">8244520</pub-id></mixed-citation></ref><ref id="pone.0103449-Weber1"><label>22</label><mixed-citation publication-type="journal"><name><surname>Weber</surname><given-names>T</given-names></name>, <name><surname>Auer</surname><given-names>J</given-names></name>, <name><surname>O'Rourke</surname><given-names>MF</given-names></name>, <name><surname>Kvas</surname><given-names>E</given-names></name>, <name><surname>Lassnig</surname><given-names>E</given-names></name>, <etal>et al</etal> (<year>2004</year>) <article-title>Arterial stiffness, wave reflections, and the risk of coronary artery disease</article-title>. <source>Circulation</source><volume>109</volume>: <fpage>184</fpage>–<lpage>189</lpage><comment>10.1161/01.CIR.0000105767.94169.E3 [doi];01.CIR.0000105767.94169.E3 [pii]</comment><pub-id pub-id-type="pmid">14662706</pub-id></mixed-citation></ref><ref id="pone.0103449-London1"><label>23</label><mixed-citation publication-type="journal"><name><surname>London</surname><given-names>GM</given-names></name>, <name><surname>Blacher</surname><given-names>J</given-names></name>, <name><surname>Pannier</surname><given-names>B</given-names></name>, <name><surname>Guerin</surname><given-names>AP</given-names></name>, <name><surname>Marchais</surname><given-names>SJ</given-names></name>, <etal>et al</etal> (<year>2001</year>) <article-title>Arterial wave reflections and survival in end-stage renal failure</article-title>. <source>Hypertension</source><volume>38</volume>: <fpage>434</fpage>–<lpage>438</lpage>.<pub-id pub-id-type="pmid">11566918</pub-id></mixed-citation></ref><ref id="pone.0103449-Baulmann2"><label>24</label><mixed-citation publication-type="journal"><name><surname>Baulmann</surname><given-names>J</given-names></name>, <name><surname>Schillings</surname><given-names>U</given-names></name>, <name><surname>Rickert</surname><given-names>S</given-names></name>, <name><surname>Uen</surname><given-names>S</given-names></name>, <name><surname>Dusing</surname><given-names>R</given-names></name>, <etal>et al</etal> (<year>2008</year>) <article-title>A new oscillometric method for assessment of arterial stiffness: comparison with tonometric and piezo-electronic methods</article-title>. <source>J Hypertens</source><volume>26</volume>: <fpage>523</fpage>–<lpage>528</lpage><comment>10.1097/HJH.0b013e3282f314f7 [doi];00004872-200803000-00022 [pii]</comment><pub-id pub-id-type="pmid">18300864</pub-id></mixed-citation></ref><ref id="pone.0103449-Armitage1"><label>25</label><mixed-citation publication-type="journal"><name><surname>Armitage</surname><given-names>GC</given-names></name> (<year>1999</year>) <article-title>Development of a classification system for periodontal diseases and conditions</article-title>. <source>Ann Periodontol</source><volume>4</volume>: <fpage>1</fpage>–<lpage>6</lpage><comment><ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1902/annals.1999.4.1.1">10.1902/annals.1999.4.1.1</ext-link> [doi]</comment><pub-id pub-id-type="pmid">10863370</pub-id></mixed-citation></ref><ref id="pone.0103449-Page1"><label>26</label><mixed-citation publication-type="journal"><name><surname>Page</surname><given-names>RC</given-names></name>, <name><surname>Eke</surname><given-names>PI</given-names></name> (<year>2007</year>) <article-title>Case definitions for use in population-based surveillance of periodontitis</article-title>. <source>J Periodontol</source><volume>78</volume>: <fpage>1387</fpage>–<lpage>1399</lpage><comment><ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1902/jop.2007.060264">10.1902/jop.2007.060264</ext-link> [doi]</comment><pub-id pub-id-type="pmid">17608611</pub-id></mixed-citation></ref><ref id="pone.0103449-Grossi1"><label>27</label><mixed-citation publication-type="journal"><name><surname>Grossi</surname><given-names>SG</given-names></name>, <name><surname>Dunford</surname><given-names>RG</given-names></name>, <name><surname>Ho</surname><given-names>A</given-names></name>, <name><surname>Koch</surname><given-names>G</given-names></name>, <name><surname>Machtei</surname><given-names>EE</given-names></name>, <etal>et al</etal> (<year>1996</year>) <article-title>Sources of error for periodontal probing measurements</article-title>. <source>J Periodontal Res</source><volume>31</volume>: <fpage>330</fpage>–<lpage>336</lpage>.<pub-id pub-id-type="pmid">8858537</pub-id></mixed-citation></ref><ref id="pone.0103449-VanBortel1"><label>28</label><mixed-citation publication-type="other">Van Bortel LM, Duprez D, Starmans-Kool MJ, Safar ME, Giannattasio C, et al. (2002) Clinical applications of arterial stiffness, Task Force III: recommendations for user procedures. Am J Hypertens 15: 445–452. S0895706101023263 [pii].</mixed-citation></ref><ref id="pone.0103449-Briggs1"><label>29</label><mixed-citation publication-type="journal"><name><surname>Briggs</surname><given-names>JE</given-names></name>, <name><surname>McKeown</surname><given-names>PP</given-names></name>, <name><surname>Crawford</surname><given-names>VL</given-names></name>, <name><surname>Woodside</surname><given-names>JV</given-names></name>, <name><surname>Stout</surname><given-names>RW</given-names></name>, <etal>et al</etal> (<year>2006</year>) <article-title>Angiographically confirmed coronary heart disease and periodontal disease in middle-aged males</article-title>. <source>J Periodontol</source><volume>77</volume>: <fpage>95</fpage>–<lpage>102</lpage><comment><ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1902/jop.2006.77.1.95">10.1902/jop.2006.77.1.95</ext-link> [doi]</comment><pub-id pub-id-type="pmid">16579709</pub-id></mixed-citation></ref><ref id="pone.0103449-Hujoel1"><label>30</label><mixed-citation publication-type="other">Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA (2000) Periodontal disease and coronary heart disease risk. JAMA 284: 1406–1410. joc00373 [pii].</mixed-citation></ref><ref id="pone.0103449-Morrison1"><label>31</label><mixed-citation publication-type="journal"><name><surname>Morrison</surname><given-names>HI</given-names></name>, <name><surname>Ellison</surname><given-names>LF</given-names></name>, <name><surname>Taylor</surname><given-names>GW</given-names></name> (<year>1999</year>) <article-title>Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases</article-title>. <source>J Cardiovasc Risk</source><volume>6</volume>: <fpage>7</fpage>–<lpage>11</lpage>.<pub-id pub-id-type="pmid">10197286</pub-id></mixed-citation></ref><ref id="pone.0103449-Tonetti2"><label>32</label><mixed-citation publication-type="journal"><name><surname>Tonetti</surname><given-names>MS</given-names></name> (<year>2009</year>) <article-title>Periodontitis and risk for atherosclerosis: an update on intervention trials</article-title>. <source>J Clin Periodontol</source><volume>36</volume> Suppl 10<fpage>15</fpage>–<lpage>19</lpage><comment>CPE1417 [pii];10.1111/j.1600-051X.2009.01417.x [doi]</comment><pub-id pub-id-type="pmid">19432627</pub-id></mixed-citation></ref><ref id="pone.0103449-Franek1"><label>33</label><mixed-citation publication-type="journal"><name><surname>Franek</surname><given-names>E</given-names></name>, <name><surname>Klamczynska</surname><given-names>E</given-names></name>, <name><surname>Ganowicz</surname><given-names>E</given-names></name>, <name><surname>Blach</surname><given-names>A</given-names></name>, <name><surname>Budlewski</surname><given-names>T</given-names></name>, <etal>et al</etal> (<year>2009</year>) <article-title>Association of chronic periodontitis with left ventricular mass and central blood pressure in treated patients with essential hypertension</article-title>. <source>Am J Hypertens</source><volume>22</volume>: <fpage>203</fpage>–<lpage>207</lpage><comment>ajh2008330 [pii];10.1038/ajh.2008.330 [doi]</comment><pub-id pub-id-type="pmid">19039308</pub-id></mixed-citation></ref><ref id="pone.0103449-Sigurdsson1"><label>34</label><mixed-citation publication-type="journal"><name><surname>Sigurdsson</surname><given-names>E</given-names></name>, <name><surname>Sigfusson</surname><given-names>N</given-names></name>, <name><surname>Sigvaldason</surname><given-names>H</given-names></name>, <name><surname>Thorgeirsson</surname><given-names>G</given-names></name>, <name><surname>Silent</surname><given-names>S</given-names></name> (<year>1996</year>) <article-title>The changes in an epidemiologic cohort study – a marker of hypertension or coronary heart disease, or both: the Reykjavik study</article-title>. <volume>27</volume>: <fpage>1140</fpage>–<lpage>1147</lpage>.</mixed-citation></ref><ref id="pone.0103449-Ainamo1"><label>35</label><mixed-citation publication-type="journal"><name><surname>Ainamo</surname><given-names>J</given-names></name>, <name><surname>Barmes</surname><given-names>D</given-names></name>, <name><surname>Beagrie</surname><given-names>G</given-names></name>, <name><surname>Cutress</surname><given-names>T</given-names></name>, <name><surname>Martin</surname><given-names>J</given-names></name>, <etal>et al</etal> (<year>1982</year>) <article-title>Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN)</article-title>. <source>Int Dent J</source><volume>32</volume>: <fpage>281</fpage>–<lpage>291</lpage>.<pub-id pub-id-type="pmid">6958657</pub-id></mixed-citation></ref><ref id="pone.0103449-Micheelis1"><label>36</label><mixed-citation publication-type="journal"><name><surname>Micheelis</surname><given-names>W</given-names></name>, <name><surname>Hoffmann</surname><given-names>T</given-names></name>, <name><surname>Holtfreter</surname><given-names>B</given-names></name>, <name><surname>Schroeder</surname><given-names>E</given-names></name> (<year>2008</year>) <article-title>Zur epidemiologischen Einschätzung der Parodontitislast in Deutschland - Versuch einer Bilanzierung</article-title>. <volume>7</volume>: <fpage>464</fpage>–<lpage>472</lpage>.</mixed-citation></ref><ref id="pone.0103449-Dietrich1"><label>37</label><mixed-citation publication-type="journal"><name><surname>Dietrich</surname><given-names>T</given-names></name>, <name><surname>Jimenez</surname><given-names>M</given-names></name>, <name><surname>Krall Kaye</surname><given-names>EA</given-names></name>, <name><surname>Vokonas</surname><given-names>PS</given-names></name>, <name><surname>Garcia</surname><given-names>RI</given-names></name> (<year>2008</year>) <article-title>Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease</article-title>. <source>Circulation</source><volume>117</volume>: <fpage>1668</fpage>–<lpage>1674</lpage><comment>CIRCULATIONAHA.107.711507 [pii];10.1161/CIRCULATIONAHA.107.711507 [doi]</comment><pub-id pub-id-type="pmid">18362228</pub-id></mixed-citation></ref><ref id="pone.0103449-Jimenez1"><label>38</label><mixed-citation publication-type="journal"><name><surname>Jimenez</surname><given-names>M</given-names></name>, <name><surname>Krall</surname><given-names>EA</given-names></name>, <name><surname>Garcia</surname><given-names>RI</given-names></name>, <name><surname>Vokonas</surname><given-names>PS</given-names></name>, <name><surname>Dietrich</surname><given-names>T</given-names></name> (<year>2009</year>) <article-title>Periodontitis and incidence of cerebrovascular disease in men</article-title>. <source>Ann Neurol</source><volume>66</volume>: <fpage>505</fpage>–<lpage>512</lpage><comment><ext-link ext-link-type="uri" xlink:href="http://dx.doi.org/10.1002/ana.21742">10.1002/ana.21742</ext-link> [doi]</comment><pub-id pub-id-type="pmid">19847898</pub-id></mixed-citation></ref><ref id="pone.0103449-McEniery1"><label>39</label><mixed-citation publication-type="journal"><name><surname>McEniery</surname><given-names>CM</given-names></name>, <name><surname>Yasmin, Hall</surname><given-names>IR</given-names></name>, <name><surname>Qasem</surname><given-names>A</given-names></name>, <name><surname>Wilkinson</surname><given-names>IB</given-names></name>, <etal>et al</etal> (<year>2005</year>) <article-title>Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT)</article-title>. <source>J Am Coll Cardiol</source><volume>46</volume>: <fpage>1753</fpage>–<lpage>1760</lpage><comment>S0735-1097(05)01781-X [pii];10.1016/j.jacc.2005.07.037 [doi]</comment><pub-id pub-id-type="pmid">16256881</pub-id></mixed-citation></ref><ref id="pone.0103449-Roman1"><label>40</label><mixed-citation publication-type="journal"><name><surname>Roman</surname><given-names>MJ</given-names></name>, <name><surname>Devereux</surname><given-names>RB</given-names></name>, <name><surname>Kizer</surname><given-names>JR</given-names></name>, <name><surname>Okin</surname><given-names>PM</given-names></name>, <name><surname>Lee</surname><given-names>ET</given-names></name>, <etal>et al</etal> (<year>2009</year>) <article-title>High central pulse pressure is independently associated with adverse cardiovascular outcome the strong heart study</article-title>. <source>J Am Coll Cardiol</source><volume>54</volume>: <fpage>1730</fpage>–<lpage>1734</lpage><comment>S0735-1097(09)02607-2 [pii];10.1016/j.jacc.2009.05.070 [doi]</comment><pub-id pub-id-type="pmid">19850215</pub-id></mixed-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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