Periodontal Disease and Incident Venous Thromboembolism: The Atherosclerosis Risk in the Community (ARIC) Study
Background and Purpose: Previous research has identified an association between periodontal disease (PD) and atherosclerotic cardiovascular disease, but the relationship between PD and venous thromboembolism (VTE) has not been studied. PD may trigger VTE through activating inflammatory, coagulation, and fibrinolysis processes associated with thrombosis. We hypothesize an independent association between PD and increased risk of VTE.
Methods: PD was assessed among ARIC participants at visit 4 (1996-1998) using self-reported tooth loss due to gum disease and clinical PD definitions based on ARIC dental exams. PD case definitions from the CDC Periodontal Disease Surveillance workgroup in collaboration with the American Academy of Periodontology (CDC/AAP) and the biofilm-gingival interface (BGI) index were used. The outcome of interest was validated VTE, including all cases of deep vein thrombosis occurring in the leg and pulmonary embolism. Follow- up time was from visit 4 to the first VTE hospitalization, dropping out of the study, death, or else, December 31, 2011. Multivariate-adjusted Cox proportional hazards regression models were used.
Results: There were a total of 424 VTE events among the 10,651 ARIC participants who provided baseline self-reported PD data and 314 VTE events among the 8,119 participants who were edentulous at visit 4 or who completed the dental exam from which baseline clinical PD data were obtained. Compared to those without periodontal disease, self-reported history of tooth loss due to gum disease was associated with higher VTE risk (HR = 1.42 (1.11, 1.82)), as was being edentulous at exam 4 [1.51 (1.07, 2.14)] using the CDC/AAP PD definition. No other statistically significant associations were observed between clinical levels of PD and VTE risk.
Conclusions: These results suggest that individuals who are edentulous or have experienced tooth loss due to PD may be at higher VTE risk.
American Heart Association EPI/Lifestyle Annual Conference (AHA)
Cowan, Logan T., Jim S. Pankow, Pamela L. Lutsey, Kamakshi Lakshminarayan, Aaron R. Folsom.
"Periodontal Disease and Incident Venous Thromboembolism: The Atherosclerosis Risk in the Community (ARIC) Study."
Biostatistics, Epidemiology, and Environmental Health Sciences Faculty Presentations.