Abstract
Background:
The purpose of this systematic review is to summarize the literature examining associations between salivary biomarkers and cardiovascular disease (CVD) status.
Contents:
An advanced search was conducted using MeSH terms related to salivary biomarkers and CVD, and entered into the PubMed, Web of Science, and Google Scholar search databases. Four hundred and thirty-three records were narrowed to 22 accepted articles. Included titles were assessed for quality using the Newcastle-Ottawa scale, and ranked into categories of low, moderate, or high.
Summary:
A total of 40 salivary biomarkers were analyzed among accepted articles. The most studied markers were salivary creatine kinase isoform MB, C-reactive protein (CRP), matrix metalloproteinase-9, troponin I, myeloperoxidase, myoglobin, and brain natriuretic peptide. Salivary CRP provided the most consistent trends. Statistically significant increases of salivary CRP were present with CVD in every study that analyzed it. The remaining six markers demonstrated varying patterns.
Outlook:
Existing studies provide insufficient data to draw definitive conclusions. Current research shows that there is an association between some salivary biomarkers and CVD, but the details of existing studies are conflicting. Despite inconclusive results, the diagnostic potential of saliva shows promise as a non-invasive means of cardiovascular risk assessment.
Acknowledgments
The authors wish to thank David Flynn at the Boston University Medical Center Alumni Medical Library for his assistance in conducting the literature searches described in this manuscript.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Humphrey SP, Williamson RT. A review of saliva: normal composition, flow, and function. J Prosthet Dent 2001;85:162–9.10.1067/mpr.2001.113778Suche in Google Scholar PubMed
2. Lee JM, Garon E, Wong DT. Salivary diagnostics. Orthodont Craniofac Res 2009;12:206–11.10.1111/j.1601-6343.2009.01454.xSuche in Google Scholar PubMed PubMed Central
3. Cardiovascular Diseases (CVDs). c2017. World Health Organization. 2017. Available at: http://www.who.int/mediacentre/factsheets/fs317/en. Accessed 26 Apr 2017.Suche in Google Scholar
4. Floriano PN, Christodoulides N, Miller CS, Ebersole JL, Spertus J, Rose BG, et al. Use of saliva-based nano-biochip tests for acute myocardial infarction at the point of care: a feasibility study. Clin Chem 2009;55:1530–8.10.1373/clinchem.2008.117713Suche in Google Scholar PubMed PubMed Central
5. Foley JD, 3rd, Sneed JD, Steinhubl SR, Kolasa JR, Ebersole JL, Lin Y, et al. Salivary biomarkers associated with myocardial necrosis: results from an alcohol septal ablation model. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;114:616–23.10.1016/j.oooo.2012.05.024Suche in Google Scholar PubMed PubMed Central
6. Mirzaii-Dizgah I, Riahi E. Salivary troponin I as an indicator of myocardial infarction. Indian J Med Res 2013;138:861–5.Suche in Google Scholar
7. Miller CS, Foley JD, 3rd, Floriano PN, Christodoulides N, Ebersole JL, Campbell CL, et al. Utility of salivary biomarkers for demonstrating acute myocardial infarction. J Dent Res 2014;93(7 Suppl):72s–9s.10.1177/0022034514537522Suche in Google Scholar PubMed PubMed Central
8. Sorsa T, Tjaderhane L, Salo T. Matrix metalloproteinases (MMPs) in oral diseases. Oral Dis 2004;10:311–8.10.1111/j.1601-0825.2004.01038.xSuche in Google Scholar PubMed
9. Boşca AB, Miclăuş V, Raţiu C, Melincovici C. Matrix metalloproteinase-8 — a salivary diagnostic biomarker related to soft tissue destruction in chronic periodontitis. Ann Rom Soc Cell Biol 2012;17:251–7.Suche in Google Scholar
10. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264–9.10.7326/0003-4819-151-4-200908180-00135Suche in Google Scholar PubMed
11. Deeks J, Dinnes J, D’Amico R, Sowden A, Sakarovitch C. Evaluating non-randomised intervention studies. Health Technol Assess 2003;7:1–173.10.3310/hta7270Suche in Google Scholar PubMed
12. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. c2014. Ottawa Hospital Research Institute. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 26 Apr 2017.Suche in Google Scholar
13. Al-Rawi NH, Shahid AM. Oxidative stress, antioxidants, and lipid profile in the serum and saliva of individuals with coronary heart disease: is there a link with periodontal health? Minerva Stomatol 2017;66:212–25.10.23736/S0026-4970.17.04062-6Suche in Google Scholar PubMed
14. Ebersole JL, Kryscio RJ, Campbell C, Kinane DF, McDevitt J, Christodoulides N, et al. Salivary and serum adiponectin and C-reactive protein levels in acute myocardial infarction related to body mass index and oral health. J Periodontal Res 2017;52:419–27.10.1111/jre.12406Suche in Google Scholar PubMed PubMed Central
15. Nguyen TT, Ngo LQ, Promsudthi A, Surarit R. Salivary lipid peroxidation in patients with generalized chronic periodontitis and acute coronary syndrome. J Periodontol 2016;87:134–41.10.1902/jop.2015.150353Suche in Google Scholar PubMed
16. Nguyen TT, Ngo LQ, Promsudthi A, Surarit R. Salivary oxidative stress biomarkers in chronic periodontitis and acute coronary syndrome. Clin Oral Investing 2016;21:2345–53.10.1007/s00784-016-2029-3Suche in Google Scholar PubMed
17. Zhang X, Wan Y, Chata R, Brazzale A, Atherton JJ, Kostner K, et al. A pilot study to demonstrate diagnostic potential of galectin-3 levels in saliva. J Clin Pathol 2016;69:1100–04.10.1136/jclinpath-2016-203631Suche in Google Scholar PubMed
18. Khalighi HR, Mortazavi H, Alipour S, Nadizadeh K. Relationship between salivary and plasma level of homocysteine in coronary artery disease. Dent Med Probl 2015;52:22–5.Suche in Google Scholar
19. Rathnayake N, Gustafsson A, Norhammar A, Kjellstrom B, Klinge B, Ryden L, et al. Salivary matrix metalloproteinase-8 and -9 and myeloperoxidase in relation to coronary heart and periodontal diseases: a subgroup report from the parokrank study (periodontitis and its relation to coronary artery disease). PLoS One 2015;10:e0126370.10.1371/journal.pone.0126370Suche in Google Scholar PubMed PubMed Central
20. Aydin S, Kobat MA, Kalayci M, Eren MN, Yilmaz M, Kuloglu T, et al. Decreased saliva/serum irisin concentrations in the acute myocardial infarction promising for being a new candidate biomarker for diagnosis of this pathology. Peptides 2014;56:141–5.10.1016/j.peptides.2014.04.002Suche in Google Scholar PubMed
21. Ebersole JL, Kryscio RJ, Campbell C, Kinane DF, McDevitt JT, Christodoulides N, et al. Serum and salivary cardiac analytes in acute myocardial infarction related to oral health status. In: Sensing technologies for global health, military medicine, and environmental monitoring IV. Vol. 9112. Baltimore, MD, USA: SPIE, 2014.Suche in Google Scholar
22. Zheng H, Li R, Zhang J, Zhou S, Ma Q, Zhou Y, et al. Salivary biomarkers indicate obstructive sleep apnea patients with cardiovascular diseases. Sci Rep 2014;4:7046.10.1038/srep07046Suche in Google Scholar PubMed PubMed Central
23. Labat C, Temmar M, Nagy E, Bean K, Brink C, Benetos A, et al. Inflammatory mediators in saliva associated with arterial stiffness and subclinical atherosclerosis. J Hypertens 2013;31:2251–8.10.1097/HJH.0b013e328363dcccSuche in Google Scholar PubMed PubMed Central
24. Rubio MC, Gonzalez PM, Ramos C, Lewin PG, Friedman SM, Puntarulo S, et al. Oxidative stress assessed in saliva from patients with acute myocardial infarction. A preliminary study. Acta Odontol Latinoam 2013;26:116–20.Suche in Google Scholar
25. Toker A, Aribas A, Yerlikaya FH, Tasyurek E, Akbuga K. Serum and saliva levels of ischemia-modified albumin in patients with acute myocardial infarction. J Clin Lab Anal 2013;27: 99–104.10.1002/jcla.21569Suche in Google Scholar PubMed PubMed Central
26. Mirzaii-Dizgah I, Hejazi SF, Riahi E, Salehi MM. Saliva-based creatine kinase mb measurement as a potential point-of-care testing for detection of myocardial infarction. Clin Oral Investig 2012;16:775–9.10.1007/s00784-011-0578-zSuche in Google Scholar PubMed
27. Shen YS, Chen WL, Chang HY, Kuo HY, Chang YC, Chu H. Diagnostic performance of initial salivary alpha-amylase activity for acute myocardial infarction in patients with acute chest pain. J Emerg Med 2012;43:553–60.10.1016/j.jemermed.2011.06.040Suche in Google Scholar PubMed
28. Buduneli E, Mantyla P, Emingil G, Tervahartiala T, Pussinen P, Baris N, et al. Acute myocardial infarction is reflected in salivary matrix metalloproteinase-8 activation level. J Periodontol 2011;82:716–25.10.1902/jop.2010.100492Suche in Google Scholar PubMed
29. Mirzaii-Dizgah I, Jafari-Sabet M. Unstimulated whole saliva creatine phosphokinase in acute myocardial infarction. Oral Dis 2011;17:597–600.10.1111/j.1601-0825.2011.01817.xSuche in Google Scholar PubMed
30. Al-Rawi NH, Atiyah KM. Salivary neuron specific enolase: an indicator for neuronal damage in patients with ischemic stroke and stroke-prone patients. Clin Chem Lab Med 2009;47:1519–24.10.1515/CCLM.2009.345Suche in Google Scholar PubMed
31. Dawber TR, Meadors GF, Moore FE, Jr. Epidemiological approaches to heart disease: the Framingham study. Am J Public Health 1951;41:279–81.10.2105/AJPH.41.3.279Suche in Google Scholar
32. Oral Infections and Vascular Disease Epidemiology Study (INVEST). c2015. National Institutes of Health. Available at: http://grantome.com/grant/NIH/R01-DE013094-15. Accessed 26 Apr 2017.Suche in Google Scholar
33. Caerphilly Prospective Study: About. c2002–17. University of Bristol School of Social and Community Medicine. Available at: http://www.bris.ac.uk/social-community-medicine/projects/caerphilly/about. Accessed 26 Apr 2017.Suche in Google Scholar
Supplementary Material:
The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2017-1018).
©2018 Walter de Gruyter GmbH, Berlin/Boston
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Artikel in diesem Heft
- Frontmatter
- Editorials
- Clinical Chemistry and Laboratory Medicine continues to shine brightly in the constellation of laboratory medicine
- The Theranos saga and the consequences
- Innovative approaches in diabetes diagnosis and monitoring: less invasive, less expensive… but less, equally or more efficient?
- Reviews
- Exploring the microbiota to better understand gastrointestinal cancers physiology
- Linking type 2 diabetes and gynecological cancer: an introductory overview
- Mini Reviews
- MicroRNAs as predictive biomarkers of response to tyrosine kinase inhibitor therapy in metastatic renal cell carcinoma
- Salivary biomarkers and cardiovascular disease: a systematic review
- Opinion Paper
- The meteoric rise and dramatic fall of Theranos: lessons learned for the diagnostic industry
- General Clinical Chemistry and Laboratory Medicine
- Uncertainty evaluation in clinical chemistry, immunoassay, hematology and coagulation analytes using only external quality assessment data
- Measurement uncertainty and metrological traceability of whole blood cyclosporin A mass concentration results obtained by UHPLC-MS/MS
- Computer-assisted interventions in the clinical laboratory process improve the diagnosis and treatment of severe vitamin B12 deficiency
- Trueness, precision and stability of the LIAISON 1-84 parathyroid hormone (PTH) third-generation assay: comparison to existing intact PTH assays
- Fibroblast growth factor 23 and renal function among young and healthy individuals
- Optimizing charge state distribution is a prerequisite for accurate protein biomarker quantification with LC-MS/MS, as illustrated by hepcidin measurement
- Quantification of human complement C2 protein using an automated turbidimetric immunoassay
- EE score: an index for simple differentiation of homozygous hemoglobin E and hemoglobin E-β0-thalassemia
- Reference Values and Biological Variations
- Algorithm on age partitioning for estimation of reference intervals using clinical laboratory database exemplified with plasma creatinine
- A simple transformation independent method for outlier definition
- Cancer Diagnostics
- Quantification of vanillylmandelic acid, homovanillic acid and 5-hydroxyindoleacetic acid in urine using a dilute-and-shoot and ultra-high pressure liquid chromatography tandem mass spectrometry method
- Cardiovascular Diseases
- Sialylated isoforms of apolipoprotein C-III and plasma lipids in subjects with coronary artery disease
- Diabetes
- Analysis of protein glycation in human fingernail clippings with near-infrared (NIR) spectroscopy as an alternative technique for the diagnosis of diabetes mellitus
- Letter to the Editor
- Preanalytical errors before and after implementation of an automatic blood tube labeling system in two outpatient phlebotomy centers
- Hemolysis interference studies: freeze method should be used in the preparation of hemolyzed samples
- The curious case of postprandial glucose less than fasting glucose: little things that matter much
- Finding best practice in internal quality control procedures using external quality assurance performance
- Evaluation of the analytical performance of a new ADVIA immunoassay using the Centaur XPT platform system for the measurement of cardiac troponin I
- Reference ranges of the Sebia free light chain ratio in patients with chronic kidney disease
- Antigen excess detection by automated assays for free light chains
- Multiple myeloma and macro creatine kinase type 1: the first case report
- Comparison of five cell-free DNA isolation methods to detect the EGFR T790M mutation in plasma samples of patients with lung cancer
- Can we use a point-of-care blood gas analyzer to measure the lactate concentration in cerebrospinal fluid of patients with suspected meningitis?
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