Table 1.
Summary of Selected Epidemiologic Observational Studies Exploring Associations between Periodontal Disease and Clinical CHD or Stroke between 2006 and 2009
| Study | N | Country | Age Range | Design | Exposure | Outcome | Adjustments | Measure of Association (95% Confidence Interval) |
|---|---|---|---|---|---|---|---|---|
| Geismar et al., 2006 | 250 | Denmark | NA | Case-control | Radiographic | CHD | 1,2,5,6 | OR 2.0 (0.77, 5.08) |
| Briggs et al., 2006 | 171 | Ireland | 40+ | Case-control | PD | CHD | 1–6,10 | OR 3.06 (1.02–9.17) |
| Holmlund et al., 2006 | 4254 | Sweden | 20–70 | Cross-sectional | Tooth # Radiographic | Self-reported CHD | 1,3,5 | OR 0.80 (0.64, 0.96) 2.69 (1.12, 6.46) |
| Rech et al., 2007 | 114 | Brazil | NR | Case-control | Periodontitis (clinical) | ACS | 1,3,6 | OR 4.5 (1.3, 15.6) |
| Rubenfire et al., 2007 | 440 | USA | NR | Case-control | Positive BANA test | ACS | 1,3,5 | OR In BANA+ participants 3.95 (1.61, 9.71) |
| Andriankaja et al., 2007 | 1461 | USA | 35–69 | Case-control | CAL | Non-fatal MI | 1,3,5–8 | OR 1.46 (1.36, 1.69) |
| Gotsman et al., 2007 | 201 | Israel | NR | Cross-sectional | CAL (% of teeth with CAL ≥ 5) | ACS | 1,5,7,8 | OR 1.03 (1.01, 1.04) |
| Nonnenmacher et al., 2007 | 90 | Germany | 40–80 | Case-control | CAL | CHD | 1–3,5,9 | OR 3.2 (1.2, 9.0) |
| Dietrich et al., 2008* | 1203 | USA (NAS) | 21–59 | Cohort | Radiographic | CHD | 1–10 | HR 2.12 (1.26, 3.60) |
| USA (NAS) | 60–84 | Cohort | Radiographic | CHD | 1–10 | HR 1.81 (NA) | ||
| Senba et al., 2008 | 6816 | Japan | < 66 | Cross-sectional | Self-report periodontitis or tooth loss | CHD men | 1–3,5,6,8,9 | OR 1.51 (0.90, 2.52) 1.54 (0.90, 2.62) |
| Senba et al., 2008 | 23,088 | Japan | < 66 | Cross-sectional | Self-report periodontitis | CHD women | 1–3,6,8,9 | OR 1.48 (0.95, 2.32) 1.68 (1.08, 2.61) |
| Lund Håheim et al., 2008 | 1173 | Norway | 48–77 | Case-control | IgG (Aa, Pg, Td, or Tf) | CHD | 1–3,5–9 | OR 1.31 (1.01, 1.69) |
| Pussinen et al., 2007b | 505 | Finland | 25–64 | Nested case-control | IgA Aa IgG Aa IgA Pg IgG Pg |
CHD & stroke combined | 1–9 | HR 1.43 (0.88, 2.31) 1.64 (1.00, 2.69) 1.53 (0.95, 2.44) 1.53 (0.93, 2.50) |
| Tu et al., 2007 | 12,223 | Scotland | ≤ 30 | Cohort | Tooth loss | Fatal CVD Fatal CHD Fatal stroke |
1,3–5,8,9 | HR 1.35 (1.03, 1.77) 1.19 (0.84, 1.69) 1.64 (0.96, 2.80) |
| Syrjala et al., 2009 | 392 | Finland | 75+ | Cross-sectional | Tooth loss | Stroke & CHD combined | 1–10 | CPR (dendate vs. edentulous)*** 0.9 (0.5,1.8) |
| Pussinen et al., 2007a | 893 | Finland | 30–59 | Nested case-control | IgA Aa IgG Aa IgA Pg IgG Pg |
Stroke | 1,2,4–10 | OR 0.83 (0.62–1.10) 0.93 (0.66–1.32) 1.22 (0.91–1.65) 1.31 (0.97–1.76) |
| Lee et al., 2006 | 5123 | USA (NHANES) | 60+ | Cross-sectional | Periodontal Health Status (PHS; a composite index of periodontitis and tooth loss) | Self-reported stroke | 1,5,6,8,10,14 | OR for PHS Class 2-5 vs. 1 1.34 (0.75, 2.38) 1.97 (0.85, 4.56) 1.99 (1.06, 3.71) 1.56 (0.95, 2.57) |
| Sim et al., 2008 | 479 | Korea | 40–79 | Case-control | CAL | Stroke** | 1–6,8–10 | OR 4.30 (2.27, 8.16) |
| Jimenez et al., 2009 | 1137 | USA (NAS) | 27–84 | Cohort | Radiographic | Stroke | 1–10 | HR 3.52 (1.59, 7.81) |
| Pradeep et al., 2010 | 200 | India | 33–68 | Case-control | PD | Stroke | 1–3 | OR 8.5 (1.1, 68.2) |
| You et al., 2009 | 22,862 | USA | 45+ | Cross-sectional | Tooth loss | Stroke** | 1–8 | OR 1.27 (1.09, 1.49) |
| Choe et al., 2009 | 867,256 | Korea | 30+ | Cohort | Tooth loss | Stroke** | 1–3,5–10 | HR 1.3 (1.2, 1.4) |
Adjustments: 1, age; 2, race; 3, sex; 4, SES (income and/or education); 5, smoking status; 6, diabetes; 7, hyperlipidemia (or continuous LDL-cholesterol and/or HDL-cholesterol); 8, hypertension (or diastolic and/or systolic blood pressure); 9, obesity; 10, alcohol consumption. Abbreviations: PD, probing depth; CAL, clinical attachment loss; CHD, coronary heart disease; ACS, acute coronary syndrome; OR, odds ratio; HR, hazard ratio; CPR, cumulative prevalence ratio; NA, not available; NAS, Normative Aging Study, Boston, MA; IgG, immunoglobulin G; IgA, immunoglobulin A; Pg, Porphyromonas gingivalis; Aa, Aggregatibacter actinomycetemcomitans. *Dietrich et al. (2008) reported results only in age subgroups, so the hazard ratio for the association between radiographic periodontal disease and incident stroke among the full cohort is not available. **Hemorrhagic strokes included. ***The study by Syrjala et al. (2009) computed a cumulative prevalence ratio by comparing risk of prevalent stroke or CHD among dentate participants in the numerator with that of edentulous participants in the denominator; therefore, it can be inferred that there was a modest, non-significant increased prevalence of stroke or CHD among edentulous participants relative to dentate participants.