This was a cross sectional baseline sub-study of consecutively enrolled participants in the National Heart Lung and Blood Institute (NHLBI) Family Intervention Trial for Heart Health (F.I.T. Heart) (n=421; mean age 48 ± 13.5 years; 36% racial/ethnic minority) designed to test the effectiveness of a screening and educational intervention for family members of patients hospitalized with CVD. Participants were eligible if they were family members or cohabitants of patients hospitalized with CVD, were 20–79 years of age, did not have CVD or diabetes, and spoke either English or Spanish. Demographic information was obtained by standardized questionnaire. All participants signed written informed consent to be a part of the study. The study was approved by the Columbia University Medical Center Internal Review Board.
Oral health status data were collected using the following standardized questions: 1) “Have you ever been informed that you have periodontal (gum) disease?”, 2) “Have you ever received treatment for periodontal disease?”, 3) “Do you have removable partial or complete dentures?”, and 4) “When was the last time you had your teeth cleaned?” Self reported measures of periodontal disease such as these have been shown to be predictive of clinical attachment loss and periodontitis (4
Dietary assessments were completed using the full length Block 98 Food Frequency Questionnaire (6
). High saturated fat intake was defined as ≥10% of calories from saturated fat per day. High dietary cholesterol intake was defined as ≥ 300 mg/day. Suboptimal fruit and vegetable intake was defined as fewer than 5 combined servings of fruits and vegetables per day. Higher alcohol intake was defined as being at or above the 75th
percentile for daily percent of calories from alcohol.
Physical activity level was assessed using standardized questions adapted from the Centers for Disease Control Behavioral Risk Factor Surveillance System Questionnaire (9
). Suboptimal exercise level was defined as exercise less than three days per week for 30 minutes per session. Current smoking status was defined by self report as smoker vs. non smoker and confirmed using carbon monoxide breath testing.
Waist circumference and body mass index (BMI) were assessed by trained examiners using NHLBI Clinical Guidelines (10
). Above optimal waist circumference was defined as > 102 centimeters [> 40 inches] in men and > 88 centimeters [> 35 inches] in women. Overweight or obese status was defined as BMI ≥ 25.0 kg/M2
Systolic and diastolic blood pressure was assessed by an automated blood pressure monitor in the Columbia University Clinical and Translational Science Award (CTSA) Center using standard protocol (11
). Hypertension was defined as a systolic blood pressure ≥ 140 mmHg or a diastolic blood pressure ≥ 90 mmHg (12
All participants underwent fasting blood draw at their baseline study visits. Serum and plasma aliquots were prepared from fasting blood samples immediately after blood draw. Determination lipids were performed on blood analyzed (Roche Diagnostics) in the Columbia University CTSA. Low density lipoprotein (LDL) cholesterol was calculated using the Friedewald equation. High sensitivity c-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2
), both inflammatory markers that are indicators of CVD risk, were systematically measured in all participants using blood collected at baseline visit. HsCRP was assessed using Kamiya hsCRP kit on serum samples. High hsCRP levels were defined as ≥ 3 mg/L vs. < 3 mg/L. HsCRP values ≥ 10 mg/L were excluded from analysis based on previous work suggesting they reflect acute/non-vascular inflammation (13
mass was measured using the PLAC test (diaDexus Inc. South San Francisco, CA, USA) on plasma samples. Elevated Lp-PLA2
levels were defined as being at or above the 75th
Metabolic syndrome was evaluated using National the Cholesterol Education Program Adult Treatment Panel III definition of the presence of 3 or more of the risk factors 1) abdominal obesity, 2) triglycerides ≥ 150 mg/dL, 3) HDL-cholesterol level < 40 mg/dL (men); < 50 mg/dL(women), 4) blood pressure ≥ 130/85 mmHg and 5) fasting glucose ≥ 110 mg/dL (14
All data were collected on standardized forms, double entered into a Microsoft Access database and exported to SAS version 9.1, SAS Institute Inc., Cary, North Carolina, USA for statistical analysis. Continuous and categorical variables were characterized using means and frequency statistics respectively. Spearman coefficients were used to assess the correlation between hsCRP and Lp-PLA2 and between each of these inflammatory markers and age. Associations between oral health and inflammatory markers, oral health and CVD lifestyle and risk factors, and between CVD lifestyle and risk factors and inflammatory markers were assessed using chi-square statistics. Multiple logistic regression models were used to assess the association between oral health exposure variables and inflammation markers, controlling for age, sex, race/ethnicity, smoking, and potential confounders.