Abstract 
Introduction
Dental infections might 
predispose toward the onset of cardiovascular disease (CVD). To date, 
only a few studies, yielding inconclusive findings, have investigated 
the potential correlation between apical periodontitis (AP) and CVD. The
 aim of this study (as the first part of a prospective study) was to 
evaluate, in the absence of CV risk factors, whether subjects with AP 
were more exposed to the pathogenetic indices of an atherosclerotic 
lesion.
Methods
Forty men between the ages of 20 and 40 
years who were free from periodontal disease, CVD, and traditional CV 
risk factors were enrolled in the study; 20 subjects had AP, and 20 
acted as controls. All subjects underwent dental examination and 
complete cardiac assessment: physical examination, electrocardiogram, 
conventional and tissue Doppler echocardiography, and measurement of 
endothelial flow reserve (EFR). The following laboratory parameters were
 tested: interleukins -1, -2, and -6 (IL-1, IL-2, IL-6), tumor necrosis 
factor alpha, and asymmetrical dimethylarginine (ADMA). Data were 
analyzed by using the 2-tailed Student's 
t test, Pearson 
t test (or Spearman 
t test for nonparametric variables), and multivariate linear regression analysis.
Results
Echocardiography revealed no abnormalities in any of the subjects studied. ADMA levels were inversely correlated with EFR (
P < .05) and directly correlated with IL-2 (
P < .001). Patients with AP presented with significantly greater blood concentrations of IL-1 (
P < .05), IL-2 (
P < .01), IL-6 (
P < .05), and ADMA (
P < .05) and a significant reduction of EFR (
P < .05).
Conclusions
Increased
 ADMA levels and their relationship with poor EFR and increased IL-2 
might suggest the existence of an early endothelial dysfunction in young
 adults with AP.
 
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