Pre-existing Cardiovascular Disease and Periodontitis: A Follow-up Study

Hujoel, Philippe P.; Drangsholt, Mark; Spiekerman, Charles; DeRouen, Timothy A.

doi:10.1177/154405910208100309

Cited by 63 publications

(33 citation statements)

References 18 publications

(9 reference statements)

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“…In addition to these risk factors, diabetic Pima Indians with severe periodontal disease had lower BMI, which may reflect underlying illness because it is associated with higher mortality rates in this population (18). Heavy smoking is strongly associated with both periodontal disease and CVD (22) and undoubtedly confounds the relationship between these diseases (23)(24)(25)(26)(27)(28). In the present study, however, smoking was not associated with periodontal disease.…”

Section: Discussioncontrasting

confidence: 47%

Periodontal Disease and Mortality in Type 2 Diabetes

et al. 2005

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OBJECTIVE—Periodontal disease may contribute to the increased mortality associated with diabetes. RESEARCH DESIGN AND METHODS—In a prospective longitudinal study of 628 subjects aged ≥35 years, we examined the effect of periodontal disease on overall and cardiovascular disease mortality in Pima Indians with type 2 diabetes. Periodontal abnormality was classified as no or mild, moderate, and severe, based on panoramic radiographs and clinical dental examinations. RESULTS—During a median follow-up of 11 years (range 0.3–16), 204 subjects died. The age- and sex-adjusted death rates for all natural causes expressed as the number of deaths per 1,000 person-years of follow-up were 3.7 (95% CI 0.7–6.6) for no or mild periodontal disease, 19.6 (10.7–28.5) for moderate periodontal disease, and 28.4 (22.3–34.6) for severe periodontal disease. Periodontal disease predicted deaths from ischemic heart disease (IHD) (P trend = 0.04) and diabetic nephropathy (P trend < 0.01). Death rates from other causes were not associated with periodontal disease. After adjustment for age, sex, duration of diabetes, HbA1c, macroalbuminuria, BMI, serum cholesterol concentration, hypertension, electrocardiographic abnormalities, and current smoking in a proportional hazards model, subjects with severe periodontal disease had 3.2 times the risk (95% CI 1.1–9.3) of cardiorenal mortality (IHD and diabetic nephropathy combined) compared with the reference group (no or mild periodontal disease and moderate periodontal disease combined). CONCLUSIONS— Periodontal disease is a strong predictor of mortality from IHD and diabetic nephropathy in Pima Indians with type 2 diabetes. The effect of periodontal disease is in addition to the effects of traditional risk factors for these diseases.

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Section: Discussioncontrasting

confidence: 47%

Periodontal Disease and Mortality in Type 2 Diabetes

et al. 2005

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“…This is consistent with other studies. [27][28][29]31 Studies reporting on this association have used a variety of definitions of periodontal disease as an exposure, and our own work has used Ͼ1 definition. Because there is almost no information on which clinical periodontal measures and their severity may be related to systemic conditions, the range of exposures reported in the literature may be one reason for the inconsistency in findings.…”

Section: Discussionmentioning

confidence: 99%

“…However, other studies have found either nonsignificant positive trends or no association after adjustment for variables considered to be confounders. [27][28][29][30][31] Concerns about the validity of the periodontitis-cardiovascular disease associations have been expressed. A review by Danesh 32 noted that studies were based on clinical measures of periodontal disease and did not have direct measures of the infection, such as bacterial counts or systemic antibody levels to oral pathogens.…”

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confidence: 99%

Periodontal Disease and Coronary Heart Disease

et al. 2005

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Background-Results from studies relating periodontal disease to cardiovascular disease have been mixed. Residual confounding by smoking and use of clinical measures of periodontal disease rather than measures of infection have been 2 major criticisms. The aims of this study were to investigate relationships between prevalent coronary heart disease (CHD) and 2 exposures, (1) clinical periodontal disease and (2) IgG antibodies to 17 oral organisms, and to evaluate the role of smoking in these relationships. Methods and Results-Our study is based on a subset of participants in the Atherosclerosis Risk in Communities (ARIC)Study, who received a complete periodontal examination during visit 4 (1996 -1998). The exposures were periodontal status and serum IgG antibody levels against 17 periodontal organisms, and the outcome was prevalent CHD at visit 4. Multivariable analyses indicate that periodontal status is not significantly associated with CHD in either ever smokers or never smokers. Similar analyses evaluating antibodies indicate that high antibodies (above the median) to Treponema denticola (odds ratio [OR]ϭ1.7; 95% CI, 1.2 to 2.3), Prevotella intermedia (ORϭ1.5; 95% CI, 1.1 to 2.0), Capnocytophaga ochracea (ORϭ1.5; 95% CI, 1.1 to 2.1), and Veillonella parvula (ORϭ1.7; 95% CI, 1.2 to 2.3) are significantly associated with CHD among ever smokers, whereas Prevotella nigrescens (ORϭ1.7; 95% CI, 1.1 to 2.6), Actinobacillus actinomycetemcomitans (ORϭ1.7; 95% CI, 1.2 to 2.7), and Capnocytophaga ochracea (ORϭ2.0; 95% CI, 1.3 to 3.0) were associated with CHD among never smokers. Conclusions-Clinical signs of periodontal disease were not associated with CHD, whereas systemic antibody response was associated with CHD in ever smokers and never smokers. These findings indicate that the quality and quantity of the host response to oral bacteria may be an exposure more relevant to systemic atherothrombotic coronary events than clinical measures.

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“…[5][6][7][8][9][10][11][12][13] Infections of periodontal structure could accelerate atherosclerosis by promoting a systemic inflammatory status through release of endotoxins, heatshock proteins, or acute-phase reactants. 26,27 Periodontitis and cardiovascular disease might also share some explanatory risk factors such as diabetes mellitus, smoking, and dyslipidemia.…”

Section: Periodontitis and Cardiovascular Diseasementioning

confidence: 99%

“…3 Established risk factors for periodontal disease are dental plaque, calculus, age, genetics, smoking, and diabetes. 4 At least 9 cohort studies [5][6][7][8][9][10][11][12][13] examined the association between periodontal disease and coronary heart disease (CHD), with conflicting results. An overview of these studies 14 showed a 15% excess risk of CHD in association with periodontal disease, with 95% confidence intervals ranging from 8% to 122%.…”

mentioning

confidence: 99%

Association Between Periodontal Disease and Left Ventricle Mass in Essential Hypertension

et al. 2003

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Abstract-Chronic periodontitis has been associated with an increased risk for cardiovascular disease. Left ventricular mass is an established independent predictor of cardiovascular disease. In the present cross-sectional study, we tested the association between periodontitis and left ventricular mass in subjects with essential hypertension. One hundred four untreated subjects with essential hypertension underwent clinical examinations, including echocardiographic study, laboratory tests, and assessment of periodontal status according to the community periodontal index of treatment needs (CPITN eriodontium is a complex and highly specialized pressure-sensing system consisting of 4 tissues (cementum, periodontal ligament, alveolar bone, and junctional and sulcular epithelia) supporting the teeth. Of these structures, periodontal ligament is a dynamic tissue with a high rate of remodeling and turnover, which connects the teeth to the alveolar bone. 1 Prevalence of periodontal disease approaches 14% over a wide age span, including younger and elderly people. 1 Periodontitis begins with a loss of alveolar bone and subsequent formation of a pocked around the tooth, the final stage being tooth mobility and loss. 2 Periodontal pocket can be detected with a periodontal probe and estimated through measurement of distance from gingival margin to the base of the periodontal pocket. 3 In a healthy periodontium, there is no loss of epithelial attachment or pocket formation, and the gingival crevice is Ͻ2 mm deep. 3 Established risk factors for periodontal disease are dental plaque, calculus, age, genetics, smoking, and diabetes. 4 At least 9 cohort studies 5-13 examined the association between periodontal disease and coronary heart disease (CHD), with conflicting results. An overview of these studies 14 showed a 15% excess risk of CHD in association with periodontal disease, with 95% confidence intervals ranging from 8% to 122%. To define the underlying mechanisms of such association, several studies, reviewed in depth by Armitage, 15 examined the potential link between periodontal disease and cardiovascular risk factors, including diabetes, smoking, hyperlipidemia, and hypertension. Surprisingly, despite the high prevalence of hypertension in the general population and its leading prognostic importance, few data are available on the relation between elevated blood pressure (BP), hypertensive organ damage, and periodontal disease. Castelli et al 16 found a proliferation of the intima and elastic layers with lumen reduction of vessels feeding the periodontal membrane in hypertensive subjects. 16 In another study, tooth position and movements were affected by the force of BP transmitted through periodontal vessels. 17 Interestingly, periodontal pulsation reflected changes in pulse pressure rather than in mean BP. 17 Left ventricular (LV) mass is abnormally increased in about one third of people with hypertension, 18 and LV hypertrophy is associated with an excess risk of cardiovascular complications independently of BP and oth...

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Pre-existing Cardiovascular Disease and Periodontitis: A Follow-up Study

Cited by 63 publications

References 18 publications

Periodontal Disease and Mortality in Type 2 Diabetes

Periodontal Disease and Mortality in Type 2 Diabetes

Periodontal Disease and Coronary Heart Disease

Association Between Periodontal Disease and Left Ventricle Mass in Essential Hypertension

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