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(Circulation. 2008;117:1668-1674.)
© 2008 American Heart Association, Inc.

Epidemiology

Age-Dependent Associations Between Chronic Periodontitis/Edentulism and Risk of Coronary Heart Disease

Thomas Dietrich, DMD, MD, MPH; Monik Jimenez, SM; Elizabeth A. Krall Kaye, MPH, PhD; Pantel S. Vokonas, MD; Raul I. Garcia, DMD, MMSc

From the Department of Health Policy and Health Services Research (T.D., M.J., E.A.K.K., R.I.G.) and Department of Periodontology and Oral Biology (T.D.), Boston University Goldman School of Dental Medicine, Boston, Mass; Department of Oral Surgery (T.D.), The School of Dentistry, University of Birmingham, Birmingham, United Kingdom; Department of Epidemiology (M.J.), Harvard School of Public Health, Boston, Mass; Department of Oral Health Policy and Epidemiology (M.J.), Harvard School of Dental Medicine, Boston, Mass; VA Normative Aging Study (P.S.V.) and VA Dental Longitudinal Study (R.I.G.), VA Boston Healthcare System, Boston, Mass; and Department of Medicine (P.S.V.), Boston University School of Medicine, Boston, Mass.

Correspondence to Thomas Dietrich, Department of Oral Surgery, The School of Dentistry, University of Birmingham, St Chad‘s Queensway, Birmingham, B4 6NN, United Kingdom. E-mail t.dietrich{at}bham.ac.uk

Received May 22, 2007; accepted January 23, 2008.

Background— Several epidemiological studies have suggested periodontitis as a risk factor for coronary heart disease (CHD), but results have been inconsistent.

Methods and Results— We evaluated the association between clinical and radiographic measures of periodontitis, edentulism, and incident CHD (angina, myocardial infarction, or fatal CHD) among 1203 men in the VA Normative Aging and Dental Longitudinal Studies who were followed up with triennial comprehensive medical and dental examinations up to 35 years (median 24 years). Cox proportional hazards models with time-varying effects of exposure and potential confounders were fit. We found a significant dose-dependent association between periodontitis and CHD incidence among men <60 years of age (hazard ratio 2.12, 95% confidence interval 1.26 to 3.60 comparing highest versus lowest category of radiographic bone loss, P for trend=0.02), independent of age, body mass index, smoking, alcohol intake, diabetes mellitus, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, hypertension, systolic and diastolic blood pressure, education, marital status, income, and occupation. No association was found among men >60 years of age. Similar results were found when the sum of probing pocket depths was used as a measure of periodontitis. Among men 60 years of age, edentulous men tended to have a higher risk of CHD than dentate men in the lowest bone loss (hazard ratio 1.61, 95% confidence interval 0.95 to 2.73) and lowest pocket depth (hazard ratio 1.72, 95% confidence interval 1.03 to 2.85) categories, independent of confounders.

Conclusions— Chronic periodontitis is associated with incidence of CHD among younger men, independent of established cardiovascular risk factors.

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