Objective: A growing body of epidemiologic, experimental, and clinical data implicates infection including that associated with chronic periodontitis, as a risk factor for atherosclerosis leading to coronary vascular disease (CVD) and stroke. We hypothesize that oral microorganisms including periodontal pathogens enter the blood stream during transient bacteremias where they play a role in atherogenesis. In the present study, we examined 138 atheromas from 106 German subjects including 29 women and 77 men between the ages of 43 and 89 years for the presence of microbial pathogens including periodontopathogens. Methods: Carotid atheromas were obtained from patients with chronic adult periodontitis by endarterectomy. The samples were examined by the polymerase chain reaction (PCR) using oligonucleotide primers specific for Chlamydia pneumoniae, human cytomegalovirus (HCMV), and Herpes simplex (HSV). Bacterial 16S rDNA was amplified using two synthetic oligonucleotide primers specific for eubacteria. The resulting PCR product was probed with digoxigenin-labeled synthetic oligonucleotides specific for Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Campylobacter rectus, Porphyromonas gingivalis and Prevotella intermedia. The samples were also tested for C-reactive protein (CRP). Results: 104 (75%) of the 138 endarterectomy specimens and 90 (84%) of 106 subjects were positive for one or more target microorganisms. Thirty-five percent were positive for HCMV, 33% for HSV, and 21% for C. pneumoniae. PCR assays indicated the presence of bacteria in 75% of the atheromas and 56% were positive for at least one of the target periodontal pathogens. Twenty-six percent were positive for B. forsythus, 26% for P. gingivalis, 15% for A. actinomycetemcomitans, 21% for P. intermedia and 10% for C. rectus. Fifty-two (86%) of the 60 periodontal pathogen-positive atheromas were positive for two or more of the target species. Almost all of the atheromas (97%) showed moderate to high levels of CRP. Conclusions: Similar to our previous studies, this study demonstrates the presence of periodontal pathogens in carotid atheromas from this German cohort. This study is consistent with the hypothesis that oral infection plays a role in atherogenesis.

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