CLINICAL STUDY: ATHEROSCLEROSIS
Periodontal disease and risk of subsequent cardiovascular disease in U.S. male physicians
T. Howard Howell, DDS*,
Paul M. Ridker, MD   ,
Umed A. Ajani, MBBS,
Charles H. Hennekens, MD|| and
William G. Christen, ScD
* Department of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Manuscript received May 25, 2000;
revised manuscript received September 12, 2000,
accepted October 16, 2000.
Reprint requests and correspondence: Dr. William G. Christen, 900 Commonwealth Avenue, Boston, Massachusetts 02115
OBJECTIVES
We sought to prospectively assess whether self-reported periodontal disease is associated with subsequent risk of cardiovascular disease in a large population of male physicians.
BACKGROUND
Periodontal disease, the result of a complex interplay of bacterial infection and chronic inflammation, has been suggested to be a predictor of cardiovascular disease.
METHODS
Physicians’ Health Study I was a randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in 22,071 U.S. male physicians. A total of 22,037 physicians provided self-reports of presence or absence of periodontal disease at study entry and were included in this analysis.
RESULTS
A total of 2,653 physicians reported a personal history of periodontal disease at baseline. During an average of 12.3 years of follow-up, there were 797 nonfatal myocardial infarctions, 631 nonfatal strokes and 614 cardiovascular deaths. Thus, for each end point, the study had >90% power to detect a clinically important increased risk of 50%. In Cox proportional hazards regression analysis adjusted for age and treatment assignment, physicians who reported periodontal disease at baseline had slightly elevated, but statistically nonsignificant, relative risks (RR) of nonfatal myocardial infarction, (RR, 1.12; 95% confidence interval [CI], 0.92 to 1.36), nonfatal stroke (RR, 1.10; CI, 0.88 to 1.37) and cardiovascular death (RR, 1.20; CI, 0.97 to 1.49). Relative risk for a combined end point of all important cardiovascular events (first occurrence of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death) was 1.13 (CI, 0.99 to 1.28). After adjustment for other cardiovascular risk factors, RRs were all attenuated and nonsignificant.
CONCLUSIONS
These prospective data suggest that self-reported periodontal disease is not an independent predictor of subsequent cardiovascular disease in middle-aged to elderly men.
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Abbreviations and Acronyms
| | CHD | = coronary heart disease | | PHS I | = Physicians’ Health Study I | | RR | = relative risk |
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