title: Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study.
abstract: OBJECTIVE
  To investigate the risk of atrial fibrillation or atrial flutter in patients with periodontitis (PD) in comparison with individuals without PD.
  
  
  METHODS
  We used the 1999-2010 Taiwanese National Health Insurance Research Database to identify cases of PD in the year 2000 matching (1:1) with persons without PD during 1999-2000 according to sex and individual age as the control group. Using Cox proportional regression analysis adjusting for potential confounders, including age, sex, and comorbidities at baseline, and average annual number of ambulatory visits and dental scaling frequency during the follow-up period, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to examine the risk of atrial fibrillation or flutter in PD patients in comparison with the control group. Subgroup analyses according to age, gender, or comorbidities were conducted to study the robustness of the association and investigate possible interaction effects.
  
  
  RESULTS
  We enrolled 393,745 patients with PD and 393,745 non-PD individuals. The incidence rates of atrial fibrillation or flutter were 200 per 105 years among the PD group and 181 per 105 years in the non-PD group (incidence rate ratio, 1.10; 95% CI, 1.06-1.14). After adjusting for potential confounders, we found an increased risk of atrial fibrillation or flutter in the PD group compared with the non-PD group (HR, 1.31; 95% CI, 1.25-1.36). The greater risk of atrial fibrillation or flutter in the PD group remained significant across all disease subgroups except hyperthyroidism and sleep apnea.
  
  
  CONCLUSIONS
  The present study results indicate an increased risk of atrial fibrillation or flutter in patients with PD. Lack of individual information about alcohol consumption, obesity, and tobacco use was a major limitation.
authors: Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.|Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
authors: Der-Yuan
authors: DY
authors: Chen
authors: Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Ching-Heng
authors: CH
authors: Lin
authors: Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.|Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
authors: Yi-Ming
authors: YM
authors: Chen
authors: Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.|Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.|Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine, Chung-Hsing University, Taichung, Taiwan.|School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.|School of Medicine, Chung-Shan Medical University, Taichung, Taiwan.|Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan.
authors: Hsin-Hua
authors: http://orcid.org/0000-0002-7304-4587
authors: HH
authors: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000209:etiology*; D001282:Atrial Flutter / Q000453:epidemiology* / Q000209:etiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000150:complications* / Q000453:epidemiology*; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D013624:Taiwan / Q000453:epidemiology