Periodontitis and diabetes associations with measures of atherosclerosis and CHD

ObjectiveDiabetes has been linked with more severe periodontal disease and with coronary heart disease (CHD). The purpose of this study was to determine if periodontal infection was a significant modifier in the risk that diabetes poses for increased carotid artery intimal-medial wall thickness (IMT) and more advanced atheroma lesions as reflected in atherosclerotic plaque calcification measured by acoustic shadowing.Methods and resultsComparisons for analyses of cardiovascular outcomes were performed based upon periodontitis and diabetes status. Periodontitis was measured using pocket depth and attachment loss at six sites per tooth. Cross-sectional data on 6048 persons aged 52-74 years were obtained from the Dental Atherosclerosis Risk in Communities Study. Participants without diabetes (n = 5257) were compared to those with diabetes (n = 791). Dependent variables were thick IMT (>1 mm), presence of acoustic shadowing, and prevalent CHD. All models were adjusted for the following covariates: gender, age, race/center, LDL and HDL cholesterol, BMI, triglycerides, hypertension, smoking, income and education. For multivariate model building, all non-normally distributed variables were transformed and multivariable logistic regression analyses were performed to evaluate the relationship between periodontal infection, diabetes, and cardiovascular outcomes. Individuals with diabetes and with severe periodontitis were found to be significantly more likely to have IMT > 1 mm [OR = 2.2, (1.4-3.5)], acoustic shadowing [OR = 2.5, (1.3-4.6)], and CHD [OR = 2.6, (1.6-4.2)] compared to those without diabetes or periodontal disease.ConclusionResults from this study suggest that among people with diabetes, periodontal disease may increase the likelihood of subclinical atherosclerotic heart disease and CHD.

► Severe periodontal disease and diabetes is associated with increased prevalence of IMT ≥ 1, acoustic shadowing, and CHD. ► Diabetes alone is associated with increased odds for IMT > 1 mm, but not shadowing or CHD. ► Periodontal disease increases the likelihood of subclinical atherosclerotic heart disease and CHD in diabetic patients. ► There is a need case definitions of periodontal disease that effectively capture systemic effects of sever forms of the disease. ► Further investigation is warranted to understand the interaction of diabetes and periodontal disease as it relates to increased prevalence of IMT, acoustic shadowing, and CHD.