Biomarkers for Cardiovascular and Periodontal Diseases

What is a biomarker? How does this relate to cardiovascular or periodontal diseases?

A biomarker is anything that can be used as an indicator of a particular disease state, but it is typically a protein which can be measured in the blood and may reflect the severity of a disease.  The two biomarkers connected to both cardiovascular diseases and periodontal disease, are C-reactive protein (CRP) and PLAC2.

C-reactive protein was discovered almost a century ago, it is a biomarker for a protein produced by the liver in response to inflammation and infection.  Recent research suggests that patients with elevated basal levels of CRP are at increased risk of hypertension, diabetes, and cardiovascular disease.  Coronary artery disease can result from white blood cells responding to chronic inflammation in the heart arteries.  A level above 2.4 has been associated with double the risk of coronary event compared to levels below 1.   Periodontal disease was found to be a cause for elevated CRP levels some years ago.   Periodontal infection involves a chronic bacterial infection possibly leading to bacterial bi-products entering the blood stream and triggering CRP to elevate.  “Periodontal disease needs to be considered as a major contributor to increased levels of CRP by the medical community,” said Dr. Steven Offenbacher, member of the American Academy of Periodontology.  

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However, CRP levels in this instance should be used only as one indicator for further exploration.  If this test is normal, it can actually be a false positive for chonic periodontal infection and inflammation.  Often, we have actually tested and treated patients with advanced periodontal disease who have no elevation of CRP whatsoever.  CRP alone is not an accurate assessment for a physician or cardiologist to use for thorough diagnosis of a chronic inflammatory state.  On the other hand, we have also treated patients with elevated CRP (high risk catagory over 2.4) who experience a reduction of CRP levels to normal after our treatment.  Studies show that the adjunctive use of a medication called Periostat will actually reduce CRP levels with traditional periodontal therapy.  CRP, or hs-CRP (high sensitivity CRP), can be requested during a routine blood draw with any physician or lab.  A patients overall health and more comprehensive labs should also be taken into consideration. While CRP is a “marker”, it is not a “player”, as we will see with the biomarker PLAC2 below.

PLAC2 is also a measure of a protein level in the blood.  This test was approved by the FDA in 2003.  PLAC2 is an enzyme which co-traffics with LDL (low density lipoproteins – bad cholesterol), then oxidizes in the arteries, leading to white blood cells coming to the area – foam cells are then formed, which leads to increased cytokines (inflammatory signaling enzymes) and the release of MMP 9  (tissue destroying enzymes)…this leads to a weakened fibrous cap (which covers the plaque build up in the arteries)…if this fibrous cap ruptures, as PLAC2 seems to promote, the person ends up with a thrombus (blood clot) – leading to heart attack or stroke. 

The only known cause of elevated PLAC2 at this time is periodontal disease.  Oral pathogens can travel into arteries from the mouth. PLAC2 is a major “player” in deadly coronary heart disease.   Anyone, especially anyone with hyperlipidemia (high cholesterol) and periodontal disease, should seriously consider having this biomarker checked.  If traditional approach periodontal treatment is not reducing this biomarker we highly recommend more definitive periodontal treatment to eliminate periodontal pathogens, chronic infection, and the chronic inflammation associated with it.  

To learn more about the PLAC2 test click here