Oral Porphyromonas gingivalis and Fusobacterium nucleatum Abundance in Subjects in Primary and Secondary Cardiovascular Prevention, with or without Heterozygous Familial Hypercholesterolemia

Round 1

Reviewer 1 Report

Low-grade chronic inflammation, promoted by dysbiosis of gut and oral microbiota, has been shown to contribute to individual susceptibility to atherosclerotic cardiovascular disease (ASCVD). High oral Porphyromonas gingivalis (Pg) and lower Fusobacterium nucleatum (Fn) concentrations have been associated with clinical and experimental atherosclerosis. The authors have shown that higher oral Pg abundance is present in very high-risk patients with previous ASCVD, with or without FH, suggesting a potential relationship with CV events. 

The conclusions are consistent with the evidence and arguments presented. And the authors addressed the main question posed. It is of limited interest because it is only of importance to the cardiovascular field. 

Minor Critique: The authors need to carefully read the manuscript to avoid grammatical errors.

Author Response

Reviewer 1

Low-grade chronic inflammation, promoted by dysbiosis of gut and oral microbiota, has been shown to contribute to individual susceptibility to atherosclerotic cardiovascular disease (ASCVD). High oral Porphyromonas gingivalis (Pg) and lower Fusobacterium nucleatum (Fn) concentrations have been associated with clinical and experimental atherosclerosis. The authors have shown that higher oral Pg abundance is present in very high-risk patients with previous ASCVD, with or without FH, suggesting a potential relationship with CV events. The conclusions are consistent with the evidence and arguments presented. And the authors addressed the main question posed. It is of limited interest because it is only of importance to the cardiovascular field.

Thank you for your positive comments.

Minor Critique: The authors need to carefully read the manuscript to avoid grammatical errors.

Thanks, the manuscript has been carefully revised according to your suggestion.

Comments and Suggestions for Authors

This paper is an interesting study evaluating oral Porphyromonas gingivalis and Fusobacterium nucleatum abundance in very high-risk patients with previous ASCVD, with or without heterozygous familial hypercholesterolemia (HeFH), in subjects with HeFH in primary prevention and healthy subjects.

Again, thanks for this positive comment.

Reviewer 2 Report

This paper is an interesting study evaluating oral Porphyromonas gingivalis and Fusobacterium nucleatum abundance in very high-risk patients with previous ASCVD, with or without heterozygous familial hypercholesterolemia (HeFH), in subjects with HeFH in primary prevention and healthy subjects.

Minor comments:

It is unclear what the total n of the study is in the abstract and materials and methods section, where it is described that 40 patients with previous ASCVD (10 with genetically proven HeFH and 30 without FH), 26 subjects.

Adapt the description for a better understanding of the study design in the sections mentioned above

Discussion section: The authors must describe in the discussion section the limitations of the study at the methodological level, study design, establishment of causal relationships or associations, as well as the perspectives of the study.

Add this section in more detail to the limitations that have already been described in the discussion. 

Author Response

Reviewer 2

Minor comments:

It is unclear what the total n of the study is in the abstract and materials and methods section, where it is described that 40 patients with previous ASCVD (10 with genetically proven HeFH and 30 without FH), 26 subjects.

Adapt the description for a better understanding of the study design in the sections mentioned above

Thank you and sorry for not being clear. The total n of subjects is 97 of which 40 in secondary prevention (10 with HeFH and 30 without HeFH), 26 HeFH in primary prevention, and 31 healthy subjects). This is now reported in the abstract and materials and methods.

Discussion section: The authors must describe in the discussion section the limitations of the study at the methodological level, study design, establishment of causal relationships or associations, as well as the perspectives of the study.

Add this section in more detail to the limitations that have already been described in the discussion. 

Thanks, the limitations of the study at the methodological level, study design, establishment of causal relationships or associations, as well as the perspectives of the study have been added per your request.