Clinical Investigation| Volume 364, ISSUE 3, P327-332, September 2022

Periodontal disease is associated with elevated atherosclerotic cardiovascular disease risk score



      Periodontal disease (PD) has been linked to a range of cardiometabolic disorders. However, the association between PD and composite cardiovascular risk has not been studied. We hypothesized that PD would be associated with an elevated atherosclerotic cardiovascular risk (ASCVD) score.


      This analysis included 12,402 participants (age 42.7 ± 18.6 years, 46.8% male, 69.6% Caucasian) from the Third National Health and Nutrition Examination Survey. Participants with a history of myocardial infarction or stroke were excluded. PD was defined as moderate (≥4mm attachment loss or ≥5 mm pocket depth in ≥2 mesial sites) or severe (≥6 mm attachment loss in ≥2 mesial sites and ≥5 mm pocket depth in ≥1 mesial site). ASCVD scores were classified categorically: low (<5.0%), borderline (5.0-7.4%), intermediate (7.5-19.9%), and high (≥20.0%). Linear and multinomial logistic regression were used to examine the association between PD and ASCVD score.


      Approximately 12.1% (n = 1499) of participants had PD. Moderate periodontitis was associated with a greater than five-fold increased odds of high-risk ASCVD score [OR (95% CI): 5.40 (4.63-6.31), p-value <0.001]. Severe periodontitis was associated with a greater than seven-fold increased odds of high-risk ASCVD score [OR (95% CI): 7.15 (5.14-9.96), p-value <0.001]. Composite periodontitis (moderate or severe) was associated with a 7.0% increase in ASCVD score [β (95% CI): 7.01 (6.53-7.50)] when modeled linearly.


      PD is associated with elevated ASCVD score. Patients with PD should be counseled regarding their elevated cardiovascular risk and risk reduction strategies should be implemented with an emphasis on routine dental care.

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