Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study
Cardiovascular disease is the number one cause of death in the United States. Cardiovascular disease and stroke top the list of leading causes of death globally. Both diseases are caused by atherosclerosis which shares common risk factors with periodontal disease. In a recent study published in 2021 in the Journal of Dental Research the authors aimed to “evaluate the causal association of periodontal disease with acute myocardial infarction and stroke, after controlling for various confounders among the Korean population.”1
This study is retrospective and followed up the participants of the National Health Insurance Service (NHIS)-Health Screening (HEALS) cohort from 2002through 2013. Of the participants recruited from HEALS (n=250,123) had no history of acute myocardial infarction or stroke between 2002 and 2005, additional participants were recruited from NHIS (n=185,352) without a history of acute myocardial infarction. After inclusion and exclusion criteria, 298,128 participants were included in the study.
Confounders and effect modifiers identified were age, sex, household income, toothbrushing frequency, smoking status, alcohol consumption, physical activity, hypertension or hypertensive medication, diabetes or diabetic medication, obesity and hypercholesterolemia or hypercholesterolemia medication. In total 18.3% of participants were healthy, 42.8% has moderate periodontal disease, and 38.9% has severe periodontal disease. The incidence rate among these three categories for acute myocardial infarction, stroke and major adverse cardiovascular events were 0.8% (healthy cohort), 4.6% (moderate PD cohort), and 5.4% (severe PD cohort).
The results of this study are inline with two previous studies that found periodontal disease was causally linked with acute myocardial infarction and stroke. The authors identified strengths and limitations of the study. Strengths included, accurate classification of periodontal conditions, inclusion of cholesterol and physical activity as confounders, evidence of causal association according to sex and age group. Limitations include, not using CAL to define PD, inability to access medical chart records, possible underestimation of association, not adjusting for chronic inflammation (i.e., obstructive pulmonary disease, rheumatoid arthritis, etc.), and misclassification bias in patients without periodontal disease. Nonetheless, the authors state the data was sufficient to evaluate a causal association.
The authors conclude by stating, “Overall, our data rectified that SPD was causally associated with AMI and stroke over 10y. Thus, SPD could exhibit an increment in the new events of AMI and stroke. Prevention and care of periodontitis could be substantially beneficial to reduce CVD.”
Do you recommend your patients have regular checkups with their PCP upon periodontal disease diagnosis? Do you regularly discuss the link between periodontal disease and acute myocardial infarction as well as stroke? Does this study highlight the importance of periodontal exams and how it can be a measure in early diagnosis of atherosclerosis?
Cho HJ, Shin MS, Song Y, Park SK, Park SM, Kim HD. Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study. J Dent Res. 2021;100(7):706-713. doi:10.1177/0022034520986097