title: Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study.
abstract: BACKGROUND
  Periodontal disease has been found to be a potential risk factor for coronary heart disease. However, its association with cerebrovascular accidents (CVAs) is much less studied.
  
  
  METHODS
  This study examines the association between periodontal disease and CVA. The study cohort comprises 9962 adults aged 25 to 74 years who participated in the First National Health and Nutrition Examination Survey and its follow-up study. Baseline periodontal status was categorized into (1) no periodontal disease, (2) gingivitis, (3) periodontitis, and (4) edentulousness. All CVAs (International Classification of Diseases, Ninth Revision [ICD-9], codes 430-438) were ascertained by hospital records for nonfatal events and death certificates for fatal events. The first CVA, nonfatal or fatal, was used to define incidence. Relative risks were estimated by hazard ratios from the Cox proportional hazard model with adjustment for several demographic variables and well-established cardiovascular risk factors. Weights were used to generate risk estimates.
  
  
  RESULTS
  Periodontitis is a significant risk factor for total CVA and, in particular, nonhemorrhagic stroke (ICD-9, 433-434 and 436-438). Compared with no periodontal disease, the relative risks (95% confidence intervals) for incident nonhemorrhagic stroke were 1.24 (0.74-2.08) for gingivitis, 2.11 (1.30-3.42) for periodontitis, and 1.41 (0.96-2.06) for edentulousness. For total CVA, the results were 1.02 (0.70-1.48) for gingivitis, 1.66 (1.15-2.39) for periodontitis, and 1.23 (0.91-1.66) for edentulousness. Increased relative risks for total CVA and nonhemorrhagic stroke associated with periodontitis were also seen in white men, white women, and African Americans. Similar results were found for fatal CVA.
  
  
  CONCLUSIONS
  Periodontal disease is an important risk factor for total CVA and, in particular, nonhemorrhagic stroke.
authors.affiliation: Department of Social and Preventive Medicine, State University of New York at Buffalo, 3435 Main St, Buffalo, NY 14214. tiejianw@acsu.buffalo.edu
authors.forename: T
authors.initials: T
authors.lastname: Wu
authors.forename: M
authors.initials: M
authors.lastname: Trevisan
authors.forename: R J
authors.initials: RJ
authors.lastname: Genco
authors.forename: J P
authors.initials: JP
authors.lastname: Dorn
authors.forename: K L
authors.initials: KL
authors.lastname: Falkner
authors.forename: C T
authors.initials: CT
authors.lastname: Sempos
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D002544:Cerebral Infarction / Q000209:etiology / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005891:Gingivitis / Q000209:etiology / Q000401:mortality; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009066:Mouth, Edentulous / Q000209:etiology / Q000401:mortality; D010518:Periodontitis / Q000150:complications / Q000401:mortality*; D012307:Risk Factors