Lars Rydén1, Kåre Buhlin2, Eva Ekstrand2, Ulf de Faire2, Anders Gustafsson2, Jacob Holmer2, Barbro Kjellström2, Bertil Lindahl2, Anna Norhammar2, Åke Nygren2, Per Näsman2, Nilminie Rathnayake2, Elisabet Svenungsson2, Björn Klinge2. 1. From Departments of Medicine K2 (L.R., U.d.F., B.K., A.N., E.S.), Dental Medicine (K.B., E.E., A.G., J.H., N.R., B.K.), and Division of Cardiovascular Epidemiology IMM (U.d.F.), Karolinska Institutet, Stockholm, Sweden; Department Medical Sciences, Uppsala University, Sweden (B.L.); Department of Clinical Sciences Danderyd, Karolinska Institutet, Stockholm, Sweden (Å.N.); Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden (P.N.); and Faculty of Odontology, Department of Periodontology, Malmö University, Sweden (B.K.). lars.ryden@ki.se. 2. From Departments of Medicine K2 (L.R., U.d.F., B.K., A.N., E.S.), Dental Medicine (K.B., E.E., A.G., J.H., N.R., B.K.), and Division of Cardiovascular Epidemiology IMM (U.d.F.), Karolinska Institutet, Stockholm, Sweden; Department Medical Sciences, Uppsala University, Sweden (B.L.); Department of Clinical Sciences Danderyd, Karolinska Institutet, Stockholm, Sweden (Å.N.); Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden (P.N.); and Faculty of Odontology, Department of Periodontology, Malmö University, Sweden (B.K.).
Abstract
BACKGROUND: The relationship between periodontitis (PD) and cardiovascular disease is debated. PD is common in patients with cardiovascular disease. It has been postulated that PD could be causally related to the risk for cardiovascular disease, a hypothesis tested in the Periodontitis and Its Relation to Coronary Artery Disease (PAROKRANK) study. METHODS AND RESULTS: Eight hundred five patients (<75 years of age) with a first myocardial infarction (MI) and 805 age- (mean 62±8), sex- (male 81%), and area-matched controls without MI underwent standardized dental examination including panoramic x-ray. The periodontal status was defined as healthy (≥80% remaining bone) or as mild-moderate (from 79% to 66%) or severe PD (<66%). Great efforts were made to collect information on possibly related confounders (≈100 variables). Statistical comparisons included the Student pairwise t test and the McNemar test in 2×2 contingency tables. Contingency tables exceeding 2×2 with ranked alternatives were tested by Wilcoxon signed rank test. Odds ratios (95% confidence intervals) were calculated by conditional logistic regression. PD was more common (43%) in patients than in controls (33%; P<0.001). There was an increased risk for MI among those with PD (odds ratio, 1.49; 95% confidence interval, 1.21-1.83), which remained significant (odds ratio, 1.28; 95% confidence interval, 1.03-1.60) after adjusting for variables that differed between patients and controls (smoking habits, diabetes mellitus, years of education, and marital status). CONCLUSIONS: In this large case-control study of PD, verified by radiographic bone loss and with a careful consideration of potential confounders, the risk of a first MI was significantly increased in patients with PD even after adjustment for confounding factors. These findings strengthen the possibility of an independent relationship between PD and MI.
BACKGROUND: The relationship between periodontitis (PD) and cardiovascular disease is debated. PD is common in patients with cardiovascular disease. It has been postulated that PD could be causally related to the risk for cardiovascular disease, a hypothesis tested in the Periodontitis and Its Relation to Coronary Artery Disease (PAROKRANK) study. METHODS AND RESULTS: Eight hundred five patients (<75 years of age) with a first myocardial infarction (MI) and 805 age- (mean 62±8), sex- (male 81%), and area-matched controls without MI underwent standardized dental examination including panoramic x-ray. The periodontal status was defined as healthy (≥80% remaining bone) or as mild-moderate (from 79% to 66%) or severe PD (<66%). Great efforts were made to collect information on possibly related confounders (≈100 variables). Statistical comparisons included the Student pairwise t test and the McNemar test in 2×2 contingency tables. Contingency tables exceeding 2×2 with ranked alternatives were tested by Wilcoxon signed rank test. Odds ratios (95% confidence intervals) were calculated by conditional logistic regression. PD was more common (43%) in patients than in controls (33%; P<0.001). There was an increased risk for MI among those with PD (odds ratio, 1.49; 95% confidence interval, 1.21-1.83), which remained significant (odds ratio, 1.28; 95% confidence interval, 1.03-1.60) after adjusting for variables that differed between patients and controls (smoking habits, diabetes mellitus, years of education, and marital status). CONCLUSIONS: In this large case-control study of PD, verified by radiographic bone loss and with a careful consideration of potential confounders, the risk of a first MI was significantly increased in patients with PD even after adjustment for confounding factors. These findings strengthen the possibility of an independent relationship between PD and MI.
Authors: James A Hamilton; Hatice Hasturk; Alpdogan Kantarci; Charles N Serhan; Thomas Van Dyke Journal: Curr Atheroscler Rep Date: 2017-11-06 Impact factor: 5.113