Abstract TP21: Association Of Periodontal Disease And Small Vessel Disease In Stroke And Transient Ischemic Attack Patients

Abstract

Introduction: Few studies have systematically investigated the association between periodontal disease (PD) and small vessel disease (SVD) in stroke/TIA patients. White matter hyperintensity (WMH) is a manifestation of SVD in the brain and is a surrogate for vascular cognitive impairment. Methods: Consecutive stroke/TIA patients admitted to our tertiary stroke center were assessed for PD as a part of a stroke study. PD was defined as moderate/severe periodontitis by Center for Disease Control/American Academy of Periodontology Working Group. Periventricular (PVWMH) and deep white matter (DWMH) were rated visually on axial FLAIR imaging using the 4-point Fazeka scale and were categorized into none/mild (grades 0-1) or moderate/severe (grades 2-3). Total WMHs were dichotomized into none/mild (grades 0-2) or moderate/severe (grades 3-6). Student t-tests were performed to test continuous variables, and X 2 test was used to compare categorical variables. Multivariable analysis was conducted using multiple logistic regression to test the association between PD and WMH. Results: A total of 861 consecutive patients, 404 with PD and 457 without PD, were compared for moderate/severe PVWMH and DWMH. Patients with PD were more likely to be African American (AA) compared to whites (55% vs. 36%, p<0.001). They were also more likely to be smokers (62% vs. 42%, p<0.001). Patients with PD were similar in age (63.7±12.0 vs. 63.4 ± 12.8), gender, hypertension, diabetes, hyperlipidemia, and atrial fibrillation status. PD was associated with total WMH (OR 1.51, 95% 1.14-2.00) and DWMH (OR 1.46, 95% 1.08-1.97). PD was not significantly associated with PVWMH (OR 1.30, 95% 0.98-1.73). These associations remained significant after adjusting for age, gender, race, hypertension, diabetes, and smoking for total WMH (Adj. OR 1.38, 95% 1.01-1.88) and DWMH (Adj. OR 1.37, 95% 1.00-1.90) and remained nonsignificant for PVWMH (Adj. OR 1.24, 95% 0.91-1.70). Conclusion: Stroke/TIA patients with PD were more likely to be AA and smokers. We report significant independent associations of PD with total WMH and DWMH manifestations of SVD. This suggests that stroke risk in AA and smokers may be partly mediated by SVD.