Periodontal Health and Outcome of Atherosclerotic Disease in the Hamburg City Health Study

Abstract

Periodontitis (PD) as chronic inflammatory disease has been linked with the development of atherosclerotic cardiovascular disease (ASCVD). However, there is a lack of data with regard to the association of PD across the extent of ASCVD and clinical outcomes, which we sought to investigate. Randomly recruited participants from the Hamburg City Health Study were included. The cohort was grouped according to severity of ASCVD at baseline: no ASCVD, monovascular disease (MonoVD), and polyvascular disease (PolyVD). PD was assessed categorically by degree of severity and continuously by clinical attachment loss. Logistic regression models were implemented to investigate the association of PD with prevalent ASCVD subtypes. Kaplan-Meier curves and Cox regression analyses were computed to investigate the associations of clinical attachment loss with major adverse cardiovascular events (composite of all-cause death, myocardial infarction, ischemic stroke, any unplanned coronary revascularization, and new diagnosis of cerebrovascular disease or peripheral arterial disease) across the extent of ASCVD. Across the 6,209 individuals included (n = 3,049, no ASCVD; n = 2,283, MonoVD; n = 877, PolyVD), participants with PolyVD had the highest rates of severe PD. On binary logistic regression analysis, severe PD was independently associated with MonoVD (odds ratio, 1.32; 95% CI, 1.09 to 1.61; P = 0.005) and PolyVD (odds ratio, 1.57; 95% CI, 1.16 to 2.13; P = 0.004). During a median follow-up of 5.5 y (95% CI, 5.3 to 5.6), a trend toward higher major adverse cardiovascular event rates was observed in individuals with ASCVD and the highest clinical attachment loss tertile. However, no independent association of mean clinical attachment loss with adverse events was noted. PD is highly prevalent in patients with more extensive ASCVD, and severe PD is associated with MonoVD and PolyVD. However, no association of PD with major adverse cardiovascular events was noted. These data suggest that PD may be associated with cardiovascular risk in the population.