Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study

H J Cho; M S Shin; Y Song; S K Park; S M Park; H D Kim

doi:10.1177/0022034520986097

Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study

J Dent Res. 2021 Jul;100(7):706-713. doi: 10.1177/0022034520986097. Epub 2021 Jan 21.

Authors

H J Cho^{1

2}, M S Shin¹, Y Song³, S K Park⁴, S M Park^{5

6}, H D Kim^{1

2}

Affiliations

¹ Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Republic of Korea.
² Dental Research Institute, Seoul National University, Seoul, Korea.
³ Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, South Australia, Australia.
⁴ Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
⁵ Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea.
⁶ Department of Family Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.

PMID: 33478309
DOI: 10.1177/0022034520986097

Abstract

This study aimed to evaluate the causal association of periodontal disease with acute myocardial infarction (AMI) and stroke, after controlling for various confounders among the Korean population. A retrospective cohort study using the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) was performed during 2002 to 2015 (baseline: 2002 to 2005; follow-up: 2006 to 2015) in the Republic of Korea. A total of 298,128 participants with no history of AMI or stroke were followed up for 10 y. AMI and stroke were defined by a diagnosis using the International Classification of Diseases, 10th Revision (ICD-10) guideline. Periodontal condition was classified into 3 groups (healthy, moderate periodontal disease, severe periodontal disease [SPD]) using the combination of ICD codes, treatment codes in the NHIS, and recommendation of periodontal treatment by the dentists in HEALS. Various confounders, such as sociodemographic, behavioral, systemic, and oral health factors, including hypercholesterolemia, were considered. Multivariable Cox regression analysis was applied to estimate adjusted incidence rate ratio (adjusted hazard ratio [aHR]) based on person-year of periodontal condition for AMI, stroke, and nonfatal major adverse cardiovascular events (MACEs) encompassing AMI or stroke controlling for various confounders. Stratified analyses according to age group, sex, and toothbrushing frequency were also performed. After controlling for various confounders, participants with SPD compared with non-SPD participants had a higher incidence by 11% for AMI (aHR, 1.11; 95% confidence interval [CI], 1.02-1.20), by 3.5% for stroke (aHR, 1.035; 95% CI, 1.01-1.07), and by 4.1% for MACEs (aHR, 1.04; 95% CI, 1.01-1.07). The association of SPD with AMI and MACE was highly modified in females and adults aged 40 to 59 y. In the total Korean population, SPD increased total AMI events by 4.3%, total stroke events by 1.4%, and the total MACEs by 1.6%. Our data confirmed that SPD was causally associated with the new events of AMI and stroke.

Keywords: Korea; cardiovascular diseases; cohort study; epidemiology; periodontitis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Follow-Up Studies
Humans
Incidence
Myocardial Infarction* / epidemiology
Myocardial Infarction* / etiology
Periodontitis*
Republic of Korea / epidemiology
Retrospective Studies
Risk Factors