Two Ends Of The Cardiovascular Spectrum

Cardiovascular disease is a class of diseases that involve the heart or blood vessels (arteries and veins). Cardiovascular disease refers to any disease that affects the cardiovascular system (as used in MeSH C14 or International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD10), ICD-10 Chapter IX: Diseases of the circulatory system), principally cardiac disease, vascular diseases of the brain and kidney, and peripheral arterial disease. The causes of cardiovascular disease are diverse but atherosclerosis and/or hypertension are the most common.
 
Cardiovascular diseases remain the biggest cause of deaths worldwide, though over the last two decades, cardiovascular mortality rates have declined in many high-income countries. At the same time cardiovascular deaths and disease have increased at an astonishingly fast rate in low- and middle-income countries. Although cardiovascular disease usually affects older adults, the antecedants of cardiovascular disease, notably atherosclerosis begin in early life, making primary prevention efforts necessary from childhood. There is therefore increased emphasis on preventing atherosclerosis by modifying risk factors, such as healthy eating, exercise, and avoidance of smoking.
 
Almost all cardiovascular disease in a population can be explained in terms of a handful of risk factors: age, gender, high blood pressure, high serum cholesterol levels, tobacco smoking, excessive alcohol consumption, family history, obesity, lack of physical activity, psychosocial factors and diabetes mellitus. While the individual contribution of each risk factor varies between different communities or ethnic groups the consistency of the overall contribution of these risk factors is remarkably strong. Some of these risk factors, such as age, gender or family history are immutable, however many important cardiovascular risk factors are modifiable by lifestyle or drug treatment.
 
Together with Drs. Heruti, Bechor, Justo and Galor, we studied 815 Israeli male adults of whom 305 had complete data and were included in the statistical analysis. In the analyzed population, 2.1% of people without erectile dysfunction (ED) had advanced periodontal disease (defined as recession of periodontal bone of 6 mm or more) in comparison to 9.8% of the mild ED and 15.8% of the moderate/severe ED populations, respectively. However, due to the relatively small groups, we could not present the odds ratio. We are now planning a large-scale study to further establish the association between the two conditions. 
 
The proposed pathogenesis for this association is based on the previous findings of DNA of periodontal pathogenic bacteria in athermanous plaques and the epidemiological association between periodontal disease and coronary heart morbidity found in many world-wide large-scale studies. And since ED too was proven to be an early sign of coronary heart disease, it is reasonable to believe that extra-oral inflammation induced by periodontal bacteria might be associated with atherosclerosis and dysfunction of vessels first in the small vessels, such as the penile vasculature, and later in larger vessels such as the coronaries. Thus, as we conclude in the article, "CPD might be associated first with ED in young men and later with coronary artery disease in middle-aged men." Laboratory studies are needed, however, to confirm that hypothesis. 
 
Indeed, it is too early to make practical recommendations based on these initial results. However, the general population, as well as healthcare providers, have to remember that oral and periodontal health conditions as well as sexual function are both parts of individual well-being. Both conditions are linked to other serious diseases such as coronary heart disease and diabetes mellitus, thus the healthcare provider has to pay attention to early signs of impaired health or function and refer the patient for evaluation by the appropriate health care worker. 
 
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