Association of periodontal health with the extent of atherosclerotic cardiovascular disease

Background: There is growing body of evidence suggesting a relationship between Periodontitis (PD), and manifestations of atherosclerotic cardiovascular disease (ASCVD). However there is a scarcity of data with regard to the interplay between PD and the extent of ASCVD, which we sought to investigate.

Methods: Data from individuals enrolled in the Hamburg City Health Study was used. Participants were grouped according to the extent of ASCVD: those without atherosclerosis were assigned to the no ASCVD group, individuals with ASCVD in only one arterial system (coronary, cerebral, or lower limb peripheral arteries) were categorized in the monovascular disease (MVD) subgroup and those with ASCVD affecting ≥2 vascular systems were placed in the polyvascular disease (PolyVD) subgroup. All participants underwent a comprehensive dental examination, and PD was classified according to the Eke&Page criteria (no/mild PD, moderate PD, or severe PD). Missings with regard to ASCVD extent were imputed. An adjusted logistic regression model (adjusted for age, sex, arterial hypertension, body-mass index, hyperlipoproteinemia, smoking [never smoking as reference], diabetes and education level [low level as reference]) was computed to investigate the association between PD and the extent of ASCVD. 

Results: In the study population of 7,842 individuals (median age 63.0 years [95%-CI: 55.0, 70.0] and n=3,944 [50%] females), the following distribution of ASCVD extent was documented: no ASCVD n=3,703 (47%), MVD n=2,826 (36%), and PolyVD n=1,405 (18%). Participants with a greater extent of ACSVD were older and had a greater burden of comorbidities. The highest prevalence of severe PD was noted in individuals with PolyVD (no ASCVD: n=432 [14%] vs. MVD: n=502 [22%] vs. PolyVD: n=242 [28%]; p<0.001). On regression analysis, severe PD was associated with the presence of both MVD and PolyVD (Table 1).

Conclusion: In this population-based study, the highest prevalence of severe PD was observed in participants with PolyVD. Moreover, an independent association between severe PD and both MVD and PolyVD was identified, highlighting the interplay between PD and atherosclerotic disease.

Table 1: Logistic regression analysis with monovascular/polyvascular disease as dependent variables and periodontitis moderate/severe periodontitis as independent variable. Odds ratios (OR) and their 95%-Confidence Interval (95%-CI) are given. The population with no ASCVD was used as reference for the dependent variable, whereas no/mild periodontitis was used as reference for the independent variable.