HMG CoA Reductase Inhibitors (Statins), LDL and Periodontal Disease

Objective: Common risk factors of periodontitis and cardiovascular diseases fuel the debate on inter-relationships. Among these factors are cholesterol and its subfractions LDL and HDL. Aim of this study is to prove whether statins may have an influence on periodontal parameters either by affecting the inflammation or the association between the disease and the cholesterol concentration.

Methods: In 4,290 randomly selected subjects aged 20-80 from the normal population (Study of Health In Pomerania, SHIP), we determined periodontal measures including dental plaque and diagnostic laboratory data, cholesterol lipid fractions, inflammation markers, and HbA1c. Statin use was registered (N=280) and behavioral and environmental risk factors were assessed.

Results: When adjusted for age, sex, smoking, fibrinogen, HbA1c, CRP, and central obesity the use of statins was significantly associated with reduced levels of LDL cholesterol (p<0.001) and supragingival plaque (p=0.018). In age and gender matched-pair analyses (n= ) the odds ratio reflecting the chance of having plaque in the third tertile as compared with the first tertile by statins was 0.49 (95% C.I. 0.29-0.82, p=0.006). Statins act as effect modifiers as their effect was most pronounced at high LDL concentrations > 130 mg/dL (3.34 mmol/L), p=0.003. The LDL reduction by statins was largest in subjects with a high burden of dental plaque, p=0.013 for interaction. Fibrates exerted effects comparable to the statins.

Conclusions: In this cross-sectional population study, the use of statins is associated with reduced LDL but of the periodontal parameters only gingival plaque was reduced. Even though the mechanism of interaction remains unclear, an interference with inflammatory processes is suggested.

This work is part of the Community Medicine Research net (CMR) of the University of Greifswald, Germany, which was funded by the Federal Ministry of Education and Research, Germany (grant no. ZZ9603).