title: Periodontal disease and risk of subsequent cardiovascular disease in U.S. male physicians.
abstract: OBJECTIVE
  We sought to prospectively assess whether self-reported periodontal disease is associated with subsequent risk of cardiovascular disease in a large population of male physicians.
  
  
  BACKGROUND
  Periodontal disease, the result of a complex interplay of bacterial infection and chronic inflammation, has been suggested to be a predictor of cardiovascular disease.
  
  
  METHODS
  Physicians' Health Study I was a randomized, double-blind, placebo-controlled trial of aspirin and beta-carotene in 22,071 U.S. male physicians. A total of 22,037 physicians provided self-reports of presence or absence of periodontal disease at study entry and were included in this analysis.
  
  
  RESULTS
  A total of 2,653 physicians reported a personal history of periodontal disease at baseline. During an average of 12.3 years of follow-up, there were 797 nonfatal myocardial infarctions, 631 nonfatal strokes and 614 cardiovascular deaths. Thus, for each end point, the study had >90% power to detect a clinically important increased risk of 50%. In Cox proportional hazards regression analysis adjusted for age and treatment assignment, physicians who reported periodontal disease at baseline had slightly elevated, but statistically nonsignificant, relative risks (RR) of nonfatal myocardial infarction, (RR, 1.12; 95% confidence interval [CI], 0.92 to 1.36), nonfatal stroke (RR, 1.10; CI, 0.88 to 1.37) and cardiovascular death (RR, 1.20; CI, 0.97 to 1.49). Relative risk for a combined end point of all important cardiovascular events (first occurrence of nonfatal myocardial infarction, nonfatal stroke or cardiovascular death) was 1.13 (CI, 0.99 to 1.28). After adjustment for other cardiovascular risk factors, RRs were all attenuated and nonsignificant.
  
  
  CONCLUSIONS
  These prospective data suggest that self-reported periodontal disease is not an independent predictor of subsequent cardiovascular disease in middle-aged to elderly men.
authors.affiliation: Department of Periodontology, Harvard School of Dental Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Howell
authors.forename: P M
authors.initials: PM
authors.lastname: Ridker
authors.forename: U A
authors.initials: UA
authors.lastname: Ajani
authors.forename: C H
authors.initials: CH
authors.lastname: Hennekens
authors.forename: W G
authors.initials: WG
authors.lastname: Christen
mesh_terms: D000328:Adult; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D002423:Cause of Death; D003327:Coronary Disease / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D004311:Double-Blind Method; D006801:Humans; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D010820:Physicians / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D019207:beta Carotene / Q000627:therapeutic use
chemical_list: D019207:beta Carotene; D001241:Aspirin