title: The role of cigarette smoking in the association between periodontal disease and coronary heart disease.
abstract: BACKGROUND
  Cigarette smoking is a significant risk factor for both coronary heart disease and periodontal disease. The goal of this study was to better understand the role of smoking in the relationship between periodontal disease and heart attack history.
  
  
  METHODS
  The study population consisted of 5,285 participants in the Third National Health and Nutrition Examination Survey (NHANES) during 1988-1994 and who were age 40 years or older when examined. The data analysis employed logistic regression models and accounted for the complex sampling design used in NHANES.
  
  
  RESULTS
  After adjustment for potential confounders, we only found significant associations between periodontal loss of attachment (LOA) and heart attack history for smokers, with odds ratios and 95% confidence interval (CI) of 2.64 (1.48 to 4.71), 3.84 (1.22 to 12.10) and 5.87 (1.91 to 18.00) for those with 2.0 to 2.99, 3.0 to 3.99, and 4 mm or more mean LOA, respectively. When the analysis was stratified by smoking status and tertile of age at heart attack, the statistically significant associations were limited to smokers who had a heart attack between the ages of 25 and 50 years, with odds ratios and 95% Cl associated with increasing mean LOA for this group of 3.29 (1.35 to 8.04), 7.32 (1.60 to 33.51), and 8.04 (1.91 to 18.00), respectively.
  
  
  CONCLUSIONS
  These results suggest that cigarette smoking is a necessary cofactor in the relationship between periodontal disease and coronary heart disease, and the increase in risk appears to be age dependent. However, the key role played by smoking in the etiology of both periodontal and heart diseases makes it difficult to determine how much of the observed association resulted from periodontal disease.
authors.affiliation: Office of Science Policy and Analysis, National Institute of Dental and Craniofacial Research, Bethesda, MD 20892-6401, USA. hymanj@email.nidr.nih.gov
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Hyman
authors.forename: Deborah M
authors.initials: DM
authors.lastname: Winn
authors.forename: Britt C
authors.initials: BC
authors.lastname: Reid
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology*; D015987:Effect Modifier, Epidemiologic; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010510:Periodontal Diseases / Q000150:complications* / Q000453:epidemiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology