Associations among Periodontitis,Calcified Carotid Artery Atheromas,and Risk of Myocardial Infarction

Abstract

Cardiovascular disease is a common cause of morbidity and premature mortality. Cardiovascular disease can be prevented when risk factors are identified early. Calcified carotid artery atheromas (CCAAs), detected in panoramic radiographs, and periodontitis have both been associated with increased risk of cardiovascular disease. This case-control study aimed to 1) investigate associations between periodontitis and CCAA detected in panoramic radiographs and 2) determine the risk of future myocardial infarctions due to CCAA combined with periodontitis. We evaluated 1,482 participants (738 cases and 744 controls) with periodontitis and CCAAs recruited from the PAROKRANK study (Periodontitis and Its Relation to Coronary Artery Disease). Participants were examined with panoramic radiographs, including the carotid regions. Associations between myocardial infarction and periodontitis combined with CCAA were evaluated in 696 cases and 696 age-, sex-, and residential area–matched controls. Periodontitis was evaluated radiographically (as degree of bone loss) and with a clinical periodontal disease index score (from clinical and radiographic assessments). We found associations between CCAA and clinical periodontal disease index score among cases (odds ratio [OR], 1.51; 95% CI, 1.09 to 2.10; P = 0.02) and controls (OR, 1.70; 95% CI, 1.22 to 2.38; P < 0.01), although not between CCAA and the degree of bone loss. In a multivariable model, myocardial infarction was associated with CCAA combined with periodontitis, as assessed by degree of bone loss (OR, 1.75; 95% CI, 1.11 to 2.74; P = 0.01). When the cohort was stratified by sex, only men showed a significant association between myocardial infarction and CCAA combined with periodontitis. Participants with clinically diagnosed periodontitis exhibited CCAA in panoramic radiographs more often than those without periodontitis, irrespective of the presence of a recent myocardial infarction. Participants with combined periodontitis and CCAA had a higher risk of having had myocardial infarction as compared with participants with either condition alone. These findings implied that patients in dental care might benefit from dentists assessing panoramic radiographs for CCAA—particularly, patients with periodontitis who have not received any preventive measures for cardiovascular disease.

Keywords

carotid artery atherosclerosis cardiovascular disease(s)inflammation radiography risk factor(s)gender differences

Get full access to this article

View all access options for this article.

References

Buhlin

Gustafsson

Ahnve

Janszky

Tabrizi

Klinge

. 2005. Oral health in women with coronary heart disease. J Periodontol. 76(4):544–550.

Carter

. 2000. Discrimination between calcified triticeous cartilage and calcified carotid atheroma on panoramic radiography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 90(1):108–110.

Caton

Armitage

Berglundh

Chapple

ILC

Jepsen

Kornman

Mealey

Papapanou

Sanz

Tonetti

. 2018. A new classification scheme for periodontal and peri-implant diseases and conditions—introduction and key changes from the 1999 classification. J Clin Periodontol. 45 Suppl 20:S1–S8.

Engebretson

Lamster

Elkind

Rundek

Serman

Demmer

Sacco

Papapanou

Desvarieux

. 2005. Radiographic measures of chronic periodontitis and carotid artery plaque. Stroke. 36(3):561–566.

Friedlander

Cohen

. 2007. Panoramic radiographic atheromas portend adverse vascular events. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 103(6):830–835.

Friedlander

. 1998. Identification of stroke prone patients by panoramic radiography. Aust Dent J. 43(1):51–54.

Friedlander

Garrett

Normam

. 2002. The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus. J Am Dent Assoc. 133(11):1516–1523.

Friedlander

Lande

. 1981. Panoramic radiographic identification of carotid arterial plaques. Oral Surg Oral Med Oral Pathol. 52(1):102–104.

Friedlander

Sung

Chung

Garrett

. 2010. Radiographic quantification of chronic dental infection and its relationship to the atherosclerotic process in the carotid arteries. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 109(4):615–621.

10.

Garoff

Ahlqvist

Levring Jäghagen

Johansson

Wester

. 2016. Carotid calcification in panoramic radiographs: radiographic appearance and the degree of carotid stenosis. Dentomaxillofac Radiol. 45(6):20160147.

11.

Garoff

Johansson

Ahlqvist

Arnerlöv

Levring Jäghagen

Wester

. 2015. Calcium quantity in carotid plaques: detection in panoramic radiographs and association with degree of stenosis. Oral Surg Oral Med Oral Pathol Oral Radiol. 120(2):269–274.

12.

Garoff

Johansson

Ahlqvist

Jäghagen

Arnerlöv

Wester

. 2014. Detection of calcifications in panoramic radiographs in patients with carotid stenoses ≥50%. Oral Surg Oral Med Oral Pathol Oral Radiol. 117(3):385–391.

13.

Gustafsson

Ahlqvist

Levring Jäghagen

. 2019. Long-term skill improvement among general dental practitioners after a short training programme in diagnosing calcified carotid artery atheromas on panoramic radiographs. Eur J Dent Educ. 23(1):54–61.

14.

Gustafsson

Ahlqvist

Näslund

Wester

Buhlin

Gustafsson

Levring Jäghagen

. 2018. Calcified carotid artery atheromas in panoramic radiographs are associated with a first myocardial infarction: a case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol. 125(2):199–204.e1.

15.

Hansson

. 2005. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 352(16):1685–1695.

16.

Johansson

Ahlqvist

Garoff

Levring Jäghagen

Meimermondt

Wester

. 2015. Carotid calcifications on panoramic radiographs: a 5-year follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol. 120(4):513–520.

17.

Lee

Chang

Polanco

Pisegna

Friedlander

. 2018. Prevalence of panoramically imaged carotid atheromas in alcoholic patients with chronic pancreatitis and comorbid diabetes. J Oral Maxillofac Surg. 76(9):1929.e1–1929.e7.

18.

Liljestrand

Mäntylä

Paju

Buhlin

Kopra

KAE

Persson

Hernandez

. 2016. Association of endodontic lesions with coronary artery disease. J Dent Res. 95(12):1358–1365.

19.

MacDonald

Chan

Harris

Vertinsky

Farman

Scarfe

. 2012. Diagnosis and management of calcified carotid artery atheroma: dental perspectives. Oral Surg Oral Med Oral Pathol Oral Radiol. 114(4):533–547.

20.

Mattila

Pussinen

Paju

. 2005. Dental infections and cardiovascular diseases: a review. J Periodontol. 76(11 suppl):2085–208.

21.

Pihlstrom

Michalowicz

Johnson

. 2005. Periodontal diseases. Lancet. 366(9499):1809–1820.

22.

Rydén

Buhlin

Ekstrand

De Faire

Gustafsson

Holmer

Kjellström

Lindahl

Norhammar

Nygren

, et al. 2016. Periodontitis increases the risk of a first myocardial infarction: a report from the PAROKRANK study. Circulation. 133(6):576–583.

23.

Wallin Bengtsson

Persson

Berglund

Renvert

. 2016. A cross-sectional study of the associations between periodontitis and carotid arterial calcifications in an elderly population. Acta Odontol Scand. 74(2):115–120.

24.

Wallin Bengtsson

Persson

Berglund

Renvert

. 2018. Carotid calcifications in panoramic radiographs are associated with future stroke or ischemic heart diseases: a long-term follow-up study. Clin Oral Investig. 23(3):1171–1179.

25.

Wallin Bengtsson

Persson

Renvert

. 2014. Assessment of carotid calcifications on panoramic radiographs in relation to other used methods and relationship to periodontitis and stroke: a literature review. Acta Odontol Scand. 72(6):401–412.

26.

Willershausen

Weyer

Peter

Weichert

Kasaj

Münzel

Willershausen

. 2014. Association between chronic periodontal and apical inflammation and acute myocardial infarction. Odontology. 102(2):297–302.

27.

World Health Organization. 2018. The top 10 causes of death [accessed 2019 July 23]. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.