La Inflamación Como el Nexo Entre la Enfermedad Periodontal y la Enfermedad Cardiovascular
Palabras clave:
periodontitis, hipertensión arterial, infarto agudo de miocardio, demencia, enfermedad cardiovascularResumen
La periodontitis es una enfermedad no transmisible, con una alta prevalencia, que oscila entre el 45% y el 50% de la población mundial, ocupando el sexto lugar entre las enfermedades más frecuentes de la humanidad. Existe suficiente evidencia que avala la relación entre la enfermedad periodontal y la enfermedad cardiovascular, responsable de aproximadamente el 45% de las muertes en países desarrollados, comprendiendo en su causalidad al infarto de miocardio, el accidente cerebrovascular, la insuficiencia cardíaca y las arritmias, que causan alrededor del 95 % de las muertes relacionadas con la enfermedad cardiovascular. Ambas patologías presentan factores de riesgo comunes ampliamente reconocidos como la diabetes y el tabaquismo, pero además manifiestan características genéticas y epigenéticas que avalan distintos mecanismos etiopatológicos. Más allá de los factores de riesgo comunes, se han propuesto dos mecanismos para explicar la relación entre la enfermedad periodontal y las cardiovasculares. Uno de ellos, constituye la invasión directa de patógenos periodontales en las células endoteliales. El otro mecanismo sugerido (vía indirecta), ocasionado por la respuesta inflamatoria sistémica que resulta en niveles crónicamente elevados de diferentes citoquinas, también relacionadas con la enfermedad vascular aterosclerótica, como IL-1β, IL-6, IL-8, TNF-α, PCR y la proteína quimioatrayente de monocitos, podría estar mediado por productos bacterianos, como los lipopolisacáridos que alcanzarían la circulación induciendo una potente respuesta inmunitaria. Estos mecanismos pueden actuar inflamando las células endoteliales, modulando el metabolismo de los lípidos y aumentando el estrés oxidativo, favoreciendo la aterosclerosis, conformando la expresión de un fenotipo arterial inflamatorio, generando el nexo entre la enfermedad periodontal y las patologías cardiovasculares.
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