title: Prospective association of periodontal disease with cardiovascular and all-cause mortality: NHANES III follow-up study.
abstract: BACKGROUND
  It has been suggested that periodontal disease (PD) was associated with an increased risk for cardiovascular diseases (CVD), although evidence is inconclusive.
  
  
  OBJECTIVE
  We first sought to prospectively evaluate the relationship of PD to CVD and all-cause mortality using a national representative sample in the United States.
  
  
  METHODS
  The study population consisted of 10,849 participants who were 30 years or older and received a periodontal examination from NHANES III mortality follow-up sample (1988-2006). CVD and all-cause deaths were ascertained from the National Death Index records. The causes of death were defined using the International Classification of Disease coding (ICD-10). The severity of PD was categorized as non-PD, modest and severe PD based on clinical attachment loss and pocket depth.
  
  
  RESULTS
  Of the study sample, 3105 and 561 participants were identified as modest and severe PD cases, respectively. After up to 18 years of follow-up, there were total 2894 deaths, of which 1225 were from CVD. The levels of inflammation markers (high sensitivity C-reactive protein, white cell count and fibrinogen) were significantly higher in men with severe PD compared to men without PD (p<0.05). The prospective associations were evaluated using multivariable Cox proportional-hazards models. After adjusting for age, gender, race, household income and traditional risk factors of CVD, severe PD was associated with an increase risk of CVD mortality and all-cause mortality in men aged 30-64 years (HR=2.13 with 95% confidence interval of 1.37-3.31 for CVD mortality; HR=1.64 with 95% confidence interval of 1.25-2.15 for all-cause mortality). In addition, significant linear trends were found in CVD and all-cause mortality across the severity of PD (p<0.001). However, no significant associations were found in men aged ≥65 and in women.
  
  
  CONCLUSIONS
  There appears to be prospective associations between PD and CVD and all-cause mortality in men aged 30-64 years. Inflammation may be one possible pathway to link PD with CVD.
authors.affiliation: Department of Cardiology, Shandong University, Jinan, China.
authors.forename: Fayun
authors.initials: F
authors.lastname: Xu
authors.forename: Bing
authors.initials: B
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010510:Periodontal Diseases / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D016016:Proportional Hazards Models; D012306:Risk