title: Periodontal disease and recurrent vascular events in stroke/transient ischemic attack patients.
abstract: Periodontal disease (PD) has been shown to be associated with incident stroke. We investigated whether PD is independently associated with recurrent vascular events and certain inflammatory markers in stroke/transient ischemic attack (TIA) patients. In this prospective, longitudinal, hospital-based cohort study, PD was assessed in stroke/TIA patients. High periodontal disease (HPD) was defined as the highest tertile of extent (% of sites) with an attachment loss of 5 mm or more. Serum interleukin-6 (IL-6), high-sensitivity C-reactive protein, and soluble intracellular adhesion molecule 1 (s-ICAM) were measured. The patients were followed for recurrent vascular events-stroke, TIA, myocardial infarction, and vascular death. In the 106 patients who were evaluated, 40 (38%) showed HPD and 27 (26%) had recurrent vascular events over a median of 24 months (range, 12-24 months). HPD patients had higher levels of IL-6 (P=.01) and s-ICAM (P=.03). HPD was associated with recurrent vascular events before (log-rank P=.01; hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.2-5.7) and after adjustment for significant confounders-age and stroke status (HR, 2.5; 95% CI, 1.1-5.5; P=.03); adjustment for possible confounders-age, male, years of education, and cardioembolic strokes (HR, 2.8; 95% CI, 1.2-6.5; P=.02); and adjustment for propensity score that accounted for all potential measured confounders (HR, 2.8; 95% CI, 1.2-6.5; P=.02). There is an independent association between HPD and recurrent vascular events in stroke/TIA patients. HPD is also associated with higher serum levels of IL-6 and s-ICAM.
authors.affiliation: Department of Neurology, University of North Carolina, Chapel Hill, North Carolina; Department of Neurology, University of South Carolina, Columbia, South Carolina. Electronic address: Souvik.Sen@uscmed.sc.edu.
authors.forename: Souvik
authors.initials: S
authors.lastname: Sen
authors.forename: Roxanne
authors.initials: R
authors.lastname: Sumner
authors.forename: James
authors.initials: J
authors.lastname: Hardin
authors.forename: Silvana
authors.initials: S
authors.lastname: Barros
authors.forename: Kevin
authors.initials: K
authors.lastname: Moss
authors.forename: James
authors.initials: J
authors.lastname: Beck
authors.forename: Steven
authors.initials: S
authors.lastname: Offenbacher
mesh_terms: D000368:Aged; D015331:Cohort Studies; D016207:Cytokines / Q000097:blood; D003773:Dental Plaque / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications* / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000453:epidemiology*; D016019:Survival Analysis
chemical_list: D016207:Cytokines
keywords: Stroke; inflammatory markers; periodontitis; prevention
references.citation: Neurology. 2009 Oct 20;73(16):1300-7
references.pmid: 19841382
references.citation: Am Heart J. 1999 Nov;138(5 Pt 2):S534-6
references.pmid: 10539867
references.citation: Cerebrovasc Dis. 2004;17 Suppl 1:43-50
references.pmid: 14694279
references.citation: Am J Med. 2012 Jun;125(6):568-75
references.pmid: 22483056
references.citation: Biometrics. 1998 Sep;54(3):948-63
references.pmid: 9750244
references.citation: Cerebrovasc Dis. 2005;20(4):226-32
references.pmid: 16123541
references.citation: Cerebrovasc Dis. 2012;34(5-6):385-92
references.pmid: 23207319
references.citation: Ann Periodontol. 2003 Dec;8(1):38-53
references.pmid: 14971247
references.citation: Periodontol 2000. 1993 Jun;2:34-45
references.pmid: 9673179
references.citation: Stroke. 2011 Jan;42(1):10-6
references.pmid: 21127302
references.citation: N Engl J Med. 2007 Mar 1;356(9):911-20
references.pmid: 17329698
references.citation: PLoS One. 2011;6(7):e21508
references.pmid: 21814546
references.citation: Nat Rev Neurol. 2010 Dec;6(12):681-94
references.pmid: 21060340
references.citation: Am J Public Health. 2011 Dec;101 Suppl 1:S339-46
references.pmid: 21551377
references.citation: Circulation. 2012 May 22;125(20):2520-44
references.pmid: 22514251
references.citation: Am Heart J. 2006 May;151(5):977-84
references.pmid: 16644317
references.citation: Stroke. 2009 Nov;40(11):3472-7
references.pmid: 19713540
references.citation: J Periodontol. 2005 Nov;76(11 Suppl):2089-100
references.pmid: 16277581
references.citation: Stroke. 2009 Jun;40(6):2276-93
references.pmid: 19423857
references.citation: N Engl J Med. 2002 Nov 21;347(21):1713-6
references.pmid: 12444191
references.citation: J Dent Res. 2012 Oct;91(10):914-20
references.pmid: 22935673
references.citation: Stroke. 2013 Apr;44(4):1026-30
references.pmid: 23422085
references.citation: Cerebrovasc Dis. 2011;31(1):57-63
references.pmid: 20980755
references.citation: Stroke. 2011 Jan;42(1):227-76
references.pmid: 20966421
references.citation: Cerebrovasc Dis. 2012;33(4):385-91
references.pmid: 22456164
references.citation: Circulation. 2007 Aug 21;116(8):928-35
references.pmid: 17684150
references.citation: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 May;95(5):559-69
references.pmid: 12738947
references.citation: Stroke. 2002 Apr;33(4):930-5
references.pmid: 11935039
references.citation: Arterioscler Thromb Vasc Biol. 2001 Nov;21(11):1816-22
references.pmid: 11701471
references.citation: Stroke. 1993 Jan;24(1):35-41
references.pmid: 7678184
references.citation: Circulation. 2002 Mar 5;105(9):1135-43
references.pmid: 11877368
references.citation: Stroke. 2004 Feb;35(2):496-501
references.pmid: 14707235
references.citation: J Periodontol. 2008 Sep;79(9):1652-8
references.pmid: 18771365
references.citation: Neurology. 2011 Sep 20;77(12):1182-90
references.pmid: 21900638
references.citation: J Am Coll Cardiol. 2000 Sep;36(3):959-69
references.pmid: 10987628
references.citation: Stroke. 2008 Nov;39(11):3096-8
references.pmid: 18688003