title: Apical periodontitis and incident cardiovascular events in the Baltimore Longitudinal Study of Ageing.
abstract: OBJECTIVE
  To evaluate whether the presence of apical periodontitis (AP), root canal treatment (RCT) and endodontic burden (EB) - as the sum of AP and RCT sites - were associated with long-term risk of incident cardiovascular events (CVE), including cardiovascular-related mortality, using data on participants in the Baltimore Longitudinal Study of Ageing (BLSA).
  
  
  METHODS
  This retrospective cohort included 278 dentate participants in the BLSA with complete medical and dental examinations. Periodontal disease (PD) and missing teeth were recorded. The total number of AP and RCT sites was determined from panoramic radiographs. EB was calculated as the sum of AP and RCT sites. Oral inflammatory burden (OIB) was calculated combining PD and EB. The main outcome was incident CVE including angina, myocardial infarction and cardiovascular-related death. Participants were monitored for up to 44 years (mean = 17.4± 11.1 years) following dental examination. Relative risks (RRs) were calculated through Poisson regression models, estimating the relationship between AP, RCT, EB, PD, OIB and incident CVE.
  
  
  RESULTS
  Mean age at baseline was 55.0 ±16.8 years and 51.4% were men. Sixty-two participants (22.3%) developed CVE. Bivariate analysis showed that PD, EB, number of teeth and OIB were associated with incident CVE. Multivariate models, adjusted for socio-demographic and medical variables, showed that age ≥60 years (RR = 3.07, 95% CI =1.68-5.62), hypertension (RR = 2.0, 95% CI = 1.16-3.46) and EB ≥3 (RR = 1.77, 95% CI = 1.04-3.02) were independently associated with incident CVE. The association between OIB and incident CVE was reduced to nonsignificance after adjustments (RR = 1.97, 95% CI = 0.83-4.70).
  
  
  CONCLUSIONS
  EB in midlife was an independent predictor of CVE amongst community-dwelling participants in the BLSA. Prospective studies are required to evaluate cardiovascular risk reduction with the treatment of AP.
authors.affiliation: Medical and Dental Center of the Military Police of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: M S
authors.initials: MS
authors.lastname: Gomes
authors.affiliation: Department of Community Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: F N
authors.initials: FN
authors.lastname: Hugo
authors.affiliation: Department of Community Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: J B
authors.initials: JB
authors.lastname: Hilgert
authors.affiliation: Postgraduate Program, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Sant'Ana Filho
authors.affiliation: Department of Community Dentistry, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
authors.forename: D M P
authors.initials: DM
authors.lastname: Padilha
authors.affiliation: National Institute on Aging, Translational Gerontology Branch, Intramural Research Program, Baltimore, MD, USA.
authors.forename: E M
authors.initials: EM
authors.lastname: Simonsick
authors.affiliation: National Institute on Aging, Translational Gerontology Branch, Intramural Research Program, Baltimore, MD, USA.
authors.forename: L
authors.initials: L
authors.lastname: Ferrucci
authors.affiliation: Department of Periodontics, School of Dentistry, University of Maryland, Baltimore, MD, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Reynolds
mesh_terms: D015142:Baltimore; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010485:Periapical Periodontitis / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012390:Root Canal Therapy
keywords: atherosclerosis; cardiovascular diseases; inflammation; oral-systemic diseases; risk factors