Apical periodontitis and incident cardiovascular events in the Baltimore Longitudinal Study of Ageing

M S Gomes; F N Hugo; J B Hilgert; M Sant'Ana Filho; D M P Padilha; E M Simonsick; L Ferrucci; M A Reynolds

doi:10.1111/iej.12468

Apical periodontitis and incident cardiovascular events in the Baltimore Longitudinal Study of Ageing

Int Endod J. 2016 Apr;49(4):334-42. doi: 10.1111/iej.12468. Epub 2015 Jun 11.

Authors

M S Gomes¹, F N Hugo², J B Hilgert², M Sant'Ana Filho³, D M P Padilha², E M Simonsick⁴, L Ferrucci⁴, M A Reynolds⁵

Affiliations

¹ Medical and Dental Center of the Military Police of Rio Grande do Sul, Porto Alegre, RS, Brazil.
² Department of Community Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
³ Postgraduate Program, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
⁴ National Institute on Aging, Translational Gerontology Branch, Intramural Research Program, Baltimore, MD, USA.
⁵ Department of Periodontics, School of Dentistry, University of Maryland, Baltimore, MD, USA.

Abstract

Aim: To evaluate whether the presence of apical periodontitis (AP), root canal treatment (RCT) and endodontic burden (EB) - as the sum of AP and RCT sites - were associated with long-term risk of incident cardiovascular events (CVE), including cardiovascular-related mortality, using data on participants in the Baltimore Longitudinal Study of Ageing (BLSA).

Methodology: This retrospective cohort included 278 dentate participants in the BLSA with complete medical and dental examinations. Periodontal disease (PD) and missing teeth were recorded. The total number of AP and RCT sites was determined from panoramic radiographs. EB was calculated as the sum of AP and RCT sites. Oral inflammatory burden (OIB) was calculated combining PD and EB. The main outcome was incident CVE including angina, myocardial infarction and cardiovascular-related death. Participants were monitored for up to 44 years (mean = 17.4± 11.1 years) following dental examination. Relative risks (RRs) were calculated through Poisson regression models, estimating the relationship between AP, RCT, EB, PD, OIB and incident CVE.

Results: Mean age at baseline was 55.0 ±16.8 years and 51.4% were men. Sixty-two participants (22.3%) developed CVE. Bivariate analysis showed that PD, EB, number of teeth and OIB were associated with incident CVE. Multivariate models, adjusted for socio-demographic and medical variables, showed that age ≥60 years (RR = 3.07, 95% CI =1.68-5.62), hypertension (RR = 2.0, 95% CI = 1.16-3.46) and EB ≥3 (RR = 1.77, 95% CI = 1.04-3.02) were independently associated with incident CVE. The association between OIB and incident CVE was reduced to nonsignificance after adjustments (RR = 1.97, 95% CI = 0.83-4.70).

Conclusions: EB in midlife was an independent predictor of CVE amongst community-dwelling participants in the BLSA. Prospective studies are required to evaluate cardiovascular risk reduction with the treatment of AP.

Keywords: atherosclerosis; cardiovascular diseases; inflammation; oral-systemic diseases; risk factors.

Publication types

Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

MeSH terms

Baltimore
Cardiovascular Diseases / epidemiology*
Cardiovascular Diseases / mortality
Female
Humans
Incidence
Longitudinal Studies
Male
Middle Aged
Periapical Periodontitis / epidemiology*
Periapical Periodontitis / therapy*
Retrospective Studies
Risk Factors
Root Canal Therapy*

Grants and funding

ZIA AG000015-53/Intramural NIH HHS/United States