Editorial comment
Periodontitis is more than a local disease. Epicardial fat tissue amounts to more than an occasional finding
A periodontite é mais do que uma doença localizada. O tecido adiposo epicárdico representa mais do que um achado ocasional
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"tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "697" "paginaFinal" => "702" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Avaliação ecocardiográfica da espessura do tecido adiposo epicárdico (TAE) em doentes com periodontite grave" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1624 "Ancho" => 1583 "Tamanyo" => 113366 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ROC curve analysis of EFT and for prediction of Periodontitis. At the cut-off value of >0.610 cm, sensitivity and specificity of MPV were 76% and 73%, respectively (AUC=0.843, 95% CI, 0.751-0.935). AUC: area under the curve, CI: confidence interval.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Emrah Erdal, Mehmet İnanir, Gülbahar Ustaoglu, İsa Sincer" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Emrah" "apellidos" => "Erdal" ] 1 => array:2 [ "nombre" => "Mehmet" "apellidos" => "İnanir" ] 2 => array:2 [ "nombre" => "Gülbahar" "apellidos" => "Ustaoglu" ] 3 => array:2 [ "nombre" => "İsa" "apellidos" => "Sincer" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204920304323?idApp=UINPBA00004E" "url" => "/21742049/0000003900000012/v1_202012240833/S2174204920304323/v1_202012240833/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Periodontitis is more than a local disease. Epicardial fat tissue amounts to more than an occasional finding" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "703" "paginaFinal" => "704" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Roberto Palma Reis" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Roberto" "apellidos" => "Palma Reis" "email" => array:1 [ 0 => "palma.reis@nms.unl.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Faculdade de Ciências Médicas da Universidade Nova de Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidade de Cardiologia do Hospital Pulido Valente, Serviço de Cardiologia do CHLN, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "A periodontite é mais do que uma doença localizada. O tecido adiposo epicárdico representa mais do que um achado ocasional" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The concept of atherosclerosis began as a local issue with the involvement of vessels of the heart, causing myocardial necrosis/ischemia; vessels of the brain, causing cerebrovascular accidents and peripheral vessels, causing intermittent claudication and other vascular limb issues.</p><p id="par0010" class="elsevierStylePara elsevierViewall">According to this concept, the significance of atherosclerotic disease would depend on the importance of the affected vessel(s). In the case of coronary disease, greater importance would be attributed to the left main or left anterior descending artery (depending, of course, on the degree of obstruction) and disease of the right coronary artery would be considered less serious.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Atherosclerosis is now identified as a systemic disease with conventional and emerging new risk factors, some of which are still unknown and may potentially affect all vascular regions.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The local concept maintains its importance for vascular intervention, but in terms of prevention, as well as the understanding of the disease, the “systemic” approach to atherosclerosis seems to be the most consensual.</p><p id="par0025" class="elsevierStylePara elsevierViewall">LDL cholesterol is the cornerstone of atherosclerosis. Today we have highly effective tools for lowering LDL and for reducing lipid atherosclerotic complications, however, even with a significant lowering of LDL, events still occur. Inflammation can explain some of this residual risk.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Inflammation and inflammatory markers have long been associated with atherosclerosis and its complications. The more consensual inflammatory markers are C-reactive protein, interleukins, blood sedimentation rate and leucocyte cell count.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">On the other hand, several inflammatory diseases, especially periodontitis, have been associated with atherosclerosis in multiple epidemiological studies.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Experimental studies in rats confirm that periodontitis induces systemic inflammation and exacerbates atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">3</span></a> In these circumstances, periodontitis represents a cause and may be a consequence of systemic inflammation, which has been linked to atherosclerosis in epidemiological and experimental studies.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Epicardial fat tissue (EFT) is the visceral fat depot of the heart. It can be assessed either by standard echocardiography, with a single thickness location, or by computed tomography, resulting in an assessment of total EFT volume.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">4</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">EFT is correlated with waist circumference and abdominal fat and is a marker of visceral fat. It has been associated with several clinical conditions, especially obesity, metabolic syndrome, diabetes, atherosclerosis and inflammation.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The extent of the role of EFT remains unclear, however it has mechanical, thermogenic, metabolic and endocrine functions. EFT can be a therapeutic target as it can be reduced with drugs, in particular with metformin.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">With the increasing prevalence of obesity and diabetes in developed countries, EFT emerges as an easy way to assess visceral adiposity and may also be a target for its treatment.</p><p id="par0065" class="elsevierStylePara elsevierViewall">EFT has been associated with inflammation and atherosclerosis in several inflammatory diseases, such as lichen planus and psoriasis.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">7,8</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In the current edition of the Journal, Erdal et al. present a paper on the assessment by echocardiography of EFT in patients with severe periodontitis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a> They studied EFT assessed by echocardiography in 33 patients with grade 3 periodontitis and compared the results with those of 33 periodontally healthy controls. The groups were similar in age, gender and conventional echocardiographic measurements and presented no significant differences in terms of diabetes, hypertension, smoking habits and dyslipidemia. However, EFF was significantly higher in patients with periodontitis. They found a significant correlation between EFT and clinical parameters of periodontitis.</p><p id="par0075" class="elsevierStylePara elsevierViewall">This study presents some points of interest, as well as some limitations.</p><p id="par0080" class="elsevierStylePara elsevierViewall">As points of interest, the authors focused on two important and frequently forgotten markers of atherosclerosis: periodontitis and EFT. They proved EFT can be different in patients with the same cardiovascular risk profile, when assessed according to conventional risk factors, and, in these circumstances, periodontitis/inflammation can be a differentiating factor. This difference may weigh in on the decision over whether or not to begin therapy in patients with intermediate risk level, assessed according to conventional risk factor scores.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The main limitations of the study are the small population size and the use of echocardiography, which provides a limited assessment of EFT. Moreover, they assume that patients with high EFT will have a higher risk of developing atherosclerosis and its complications, such as coronary artery disease, but this concept is not supported, and could not be proven in the present case-control study. A case-control study can evidence an association of factors, but not causality.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion, this interesting paper highlights the importance of periodontitis and EFT in cardiovascular risk. They conclude that both markers are linked and assume they represent a high atherosclerotic risk.</p><p id="par0095" class="elsevierStylePara elsevierViewall">More importantly, we need to define whether we are facing risk markers or risk factors, meaning whether these clinical markers can be reversed not only as parameters, but especially in terms of reducing the cardiovascular risk in primary and secondary prevention.</p><p id="par0100" class="elsevierStylePara elsevierViewall">A long term randomized prospective study, with an adequate sample size, can provide answers to important question. Until we have these results, periodontitis and EFT are important markers of atherosclerosis. In addition, in terms of periodontitis, oral health must be maintained, not only for general health and but also possibly for vascular health. EFT associated with obesity and other metabolic diseases must be treated according to current guidelines.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0050" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atherosclerosis and inflammation: overview and updates" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.R. 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| 2023 March | 28 | 20 | 48 |
| 2023 February | 24 | 12 | 36 |
| 2023 January | 17 | 16 | 33 |
| 2022 December | 30 | 20 | 50 |
| 2022 November | 40 | 25 | 65 |
| 2022 October | 41 | 21 | 62 |
| 2022 September | 24 | 42 | 66 |
| 2022 August | 21 | 23 | 44 |
| 2022 July | 23 | 43 | 66 |
| 2022 June | 20 | 22 | 42 |
| 2022 May | 22 | 32 | 54 |
| 2022 April | 21 | 34 | 55 |
| 2022 March | 21 | 41 | 62 |
| 2022 February | 27 | 36 | 63 |
| 2022 January | 19 | 30 | 49 |
| 2021 December | 23 | 31 | 54 |
| 2021 November | 21 | 33 | 54 |
| 2021 October | 32 | 39 | 71 |
| 2021 September | 22 | 19 | 41 |
| 2021 August | 29 | 35 | 64 |
| 2021 July | 23 | 28 | 51 |
| 2021 June | 53 | 27 | 80 |
| 2021 May | 39 | 39 | 78 |
| 2021 April | 104 | 78 | 182 |
| 2021 March | 37 | 26 | 63 |
| 2021 February | 64 | 23 | 87 |
| 2021 January | 63 | 35 | 98 |
| 2020 December | 21 | 4 | 25 |
Show all
