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Case dental researcher explores link between gum disease and heart disease in HIV patients

Patients with HIV, who are taking a cocktail of life-saving medicines, may be at risk for developing heart disease at an accelerated rate. This situation may provide a unique opportunity to study the link between oral health and heart disease.

Lance T. Vernon, DMD, MPH, a researcher from the Case Western Reserve University School of Dental Medicine, has received a five-year, $650,000 grant from the National Institute of Dental and Craniofacial Research (part of the National Institutes of Health). He will follow 150 HIV patients across two years to examine their oral health and track changes in their systemic health for the study, “Oral Link to Vascular Disease in an HIV-1 Cohort.”

“If we can show that there is a link between periodontal (gum) disease and heart disease in this cohort, it will further the evidence that oral health is very much connected to general health,” said Vernon. “If so, then more effective control of periodontal disease may well lower the risk of heart disease, especially in at-risk populations such as those with HIV.”

Many HIV patients control their disease with a drug regimen known as HAART (highly active antiviral regiment therapy). This regimen adds years of life, but can also have side effects that speed up the development of heart disease. “One study has shown that those with HIV taking HAART have changes in their blood vessels at almost 10 times the rate of those without HIV,” said Vernon. “Changes that might take a decade to occur in otherwise healthy individuals may be detectable in just a few years in this cohort.”

Growing evidence from studies within the dental community has shown a link between the bacteria which cause periodontal disease and heart disease. The exact mechanism is unclear but, Vernon said, this study may help shed light on that link.

Vernon will test for the presence of three predominant bacteria (Treponema denticola, Porphyromonas gingivalis and Bacteroides forsythus) associated with periodontal disease. Using modern technology to look at the bacterial DNA, he will be able to determine the presence of bacteria from samples of plaque taken from below the patient’s gum-line.

His hypothesis is that, in his cohort and across two years, those with high levels of periodontal disease will accelerate the rate of progression towards atherosclerosis, as compared to those with lower levels of periodontal disease.

In addition to looking at oral health parameters, patients will also be tested for their insulin sensitivity, lipid levels, percent body fat, diet, level of exercise, quality of life and inflammatory markers in their blood. An ultrasound machine will be used to test the functioning of arteries in the arm and the size of arteries in the neck, since both are early warning signs of the hardening of the arteries and a risk factor for heart attacks and strokes.

Eligible patients will be recruited from the Cleveland Clinic, MetroHealth Medical Center, the Center for Aids Research at University Hospitals of Cleveland and the Louis Stokes Veterans Administration Hospital.

The grant also is a career development award that enables Vernon to take doctoral-level courses related to his area of research. Throughout the study, he also will work alongside mentors from Case School of Medicine and University Hospitals, such as Michael Lederman from the Center for Aids Research; Chris Whalen from the Department of Epidemiology and Infectious Diseases; Ravi Nair, from Division of Cardiology, and Zahra Toossi from the Infectious Disease Core Laboratory. His mentors from the Case School of Dental Medicine include Aaron Weinberg, chair of biological sciences, and Nabil Bissada, chair of the department of periodontics.

 

About Case Western Reserve University

Case is among the nation's leading research institutions. Founded in 1826 and shaped by the unique merger of the Case Institute of Technology and Western Reserve University, Case is distinguished by its strengths in education, research, service, and experiential learning. Located in Cleveland, Case offers nationally recognized programs in the Arts and Sciences, Dental Medicine, Engineering, Law, Management, Medicine, Nursing, and Social Work. http://www.case.edu.