Skybchyk O. Optimization of prevention and complex treatment of generalized periodontitis using statins in patients with coronary artery disease

The thesis presents specified and supplemented scientific data on the prevalence and structure of periodontal disease in patients with coronary artery disease (CAD). Features of clinical course of chronic generalized periodontitis CGP in the settings of CAD were studied, taking into account gender characteristics and degree of CGP severity. The data from studies on disturbances of microbiota in periodontal pockets (PP) in patients with CGP and CAD were supplemented, and the most common periodontopathogenic cultures associated with CAD were established. The ultrastructural changes of gingival mucosa in patients with CGP and CAD were described in detail, in particular, the disturbance of periodontal microvasculature in the settings of CAD. An analysis of relationship between lipid metabolism indicators and degree of severity of CGP in CAD patients was carried out. To increase the effectiveness of complex treatment and prevention of CGP in CAD patients, the therapeutic effect of a gel composition based on atorvastatin was developed and evaluated for the first time. In order to conduct a scientific study 130 CAD patients were included undergoing inpatient treatment for CAD in cardiology department and 35 people with CGP without somatic diseases. According to results of examination periodontal diseases were detected in 93.08±2.23% of the examined patients. CGP was diagnosed most often (87.69±2.88%), (р<0.05). It was established that 50.00±6.93% of patients with I degree CGP were being treated for II functional class (FC) angina pectoris (p<0.05). More severe clinical forms of CAD – II-III FC angina and cardiosclerosis were observed with II and III degree CGP. The majority of III degree CGP patients (45.00±11.12%) had II-III FC exertional angina and diffuse cardiosclerosis (p<0.05). It was established that hypertensive disease (HD) was observed in 81.58±3.63% of patients with CAD and CGP. HD was more often in patients with II and III degree CGP and significantly less frequent in the initial-I degree CGP (p<0.05). During periodontal probing, it was established that the average value of the depth of PP in patients with CGP and CAD was higher compared to comparison group (4.43±0.15 mm vs. 3.53±0.18 mm; p<0.001). The level of loss of epithelial attachment in the study group was characterized by a greater value than in the comparison group (4.01±0.18 mm vs. 2.71±0.25 mm; p<0.001). The value of the level of gingival recession in patients with CGP and CAD was 2.01±0.10 mm, which is higher than in the comparison group – 1.57±0.15 mm (р<0.05). The analysis of indices PMA, PBI and PSR showed that the degree of inflammatory changes in the periodontal tissues was more pronounced in patients with CGP in the settings of CAD than in subjects with CGP without CAD. The results of determining the state of oral hygiene in the study participants showed an unsatisfactory level of hygiene in both groups (p>0.05). It was established that periodontopathogens Agg. Actinomycetemcomitans, P. intermedia, Fusobacterium spp. are significantly associated with CAD (p<0.05). The statistical analysis performed shows higher values of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol, and triglycerides in patients with CAD and CGP than in patients with CAD and clinically healthy periodontium (p<0.05). It was established that TC, LDL-C and atherogenicity coefficient significantly increase with CGP severity (p<0.05). The study of the pathological process in the periodontal tissues in the settings of CAD at the ultrastructural level enabled us to trace changes in the gingival mucosa in all its layers, which are mostly specific to hypoxia. A disturbance of hemomicrocirculatory bed, represented by narrowing or dilation of blood capillaries, indicates changes in the local blood circulation of the periodontal tissues associated with the pathology of the cardiovascular system. A scheme of therapeutic and preventive measures was developed to optimize the treatment and prevention of CGP in patients with CAD. It includes the administration of a gel composition based on statin. Significantly lower values of PP depth were established during the periodontal probing in patients with CGP and CAD who used gel composition than in patients who were prescribed standard antiseptics. A higher rate of reduction of PMA and PBI indices after treatment was observed in study group than in comparison groups (p<0.05). The results of assessment of therapeutic and preventive measures in the long-term indicated the stabilization of the periodontal tissue condition in patients with CGP and CAD, who repeatedly used gel composition (p<0.05). The proven therapeutic effectiveness of the developed gel composition based on atorvastatin allows it to be recommended as an additional local medication in complex treatment and prevention of inflammatory and dystrophic-inflammatory periodontal diseases in patients with CAD.