Impact of severe periodontitis and diabetes mellitus on recurrent cardiovascular outcomes

Abstract

Background

This post hoc analysis of the Periodontitis and Coronary Heart Disease study (ClinicalTrials.gov Identifier: NCT01045070) aimed to determine the association between diabetes and recurrent cardiovascular events (CVEs) in patients with cardiovascular disease (CVD) and severe periodontitis. Another objective was to examine the link between diabetes and severe periodontitis.

Methods

A cohort of 1,002 stationary patients with angiographically proven CVD was included. The patients were examined for the prevalence of diabetes (severity levels: diet, oral antidiabetic drugs, and insulin) and severe periodontitis (≥30% of teeth with ≥5 mm of proximal attachment loss). Recurrent CVEs were summarized as a combined endpoint (myocardial infarction, stroke/transient ischemic attack, cardiovascular death, and stroke-related death). After a 10-year follow-up period, survival analyses were carried out. Hazard ratios (HRs) were adjusted for known cardiac risk factors using Cox regression.

Results

A total of 792 patients completed follow-up. The overall incidence of the combined endpoint was 42.8%. The highest HR for CVEs was observed in patients with both diabetes and severe periodontitis (HR = 2.19, 95% confidence interval [CI] 1.59-3.02). HRs were lower in subjects with only periodontitis (HR = 1.52, 95% CI = 1.14-2.04) or only diabetes (HR = 1.88, 95% CI = ∖1.35-2.63). Patients with diabetes who took drugs or required insulin were more likely to have severe periodontitis than patients without diabetes.

Conclusion

Patients with diabetes or severe periodontitis were at an increased risk of recurrent CVEs. An association was also found between diabetes and severe periodontitis prevalence.

Clinical trial registration

ClinicalTrials.gov Identifier: NCT01045070

Plain language summary

Periodontitis is a serious gum disease that damages the tissue that supports teeth. In its final stage, it can result in tooth loss. Furthermore, studies have shown an association between periodontitis and cardiovascular disease (CVD) and diabetes mellitus. The objective of this study was to investigate the relationship between diabetes and recurrent cardiovascular events (CVEs) in patients with CVD and severe periodontitis. Another objective was to examine the link between diabetes and severe periodontitis. Thus, 1,002 inpatients with CVD were examined for periodontal disease and other medical conditions, such as diabetes mellitus, at the time of the baseline examination. Ten years later, questionnaires and patient records were used to determine whether new CVEs had occurred. CVEs include myocardial infarction, stroke/transient ischemic attack, cardiovascular death, and death caused by stroke. The results showed that severe periodontitis and diabetes mellitus, especially when the two conditions occurred together, increased the risk of CVEs. Furthermore, a higher percentage of patients with diabetes also suffered from severe periodontitis. Further studies should clarify whether periodontal and antidiabetic therapies reduce the risk of CVEs.