Association of Childhood Oral Infections With Cardiovascular Risk Factors and Subclinical Atherosclerosis in Adulthood

Abstract

Importance: Severe forms of common chronic oral infections or inflammations are associated with increased cardiovascular risk in adults. To date, the role of childhood oral infections in cardiovascular risk is not known because no long-term studies have been conducted.

Objective: To investigate whether signs of oral infections in childhood are associated with cardiovascular risk factors and subclinical atherosclerosis in adulthood.

Design, setting, and participants: The cohort study (n = 755) was derived from the Cardiovascular Risk in Young Finns Study, an ongoing prospective cohort study in Finland initiated in 1980. Participants underwent clinical oral examinations during childhood, when they were aged 6, 9, or 12 years and a clinical cardiovascular follow-up in adulthood in 2001 at age 27, 30, or 33 years and/or in 2007 at age 33, 36, or 39 years. Cardiovascular risk factors were measured at baseline and during the follow-up until the end of 2007. Final statistical analyses were completed on February 19, 2019.

Main outcomes and measures: Four signs of oral infections (bleeding on probing, periodontal probing pocket depth, caries, and dental fillings) were documented. Cumulative lifetime exposure to 6 cardiovascular risk factors was calculated from dichotomized variables obtained by using the area-under-the-curve method. Subclinical atherosclerosis (ie, carotid artery intima-media thickness [IMT]) was quantified in 2001 (n = 468) and 2007 (n = 489).

Results: This study included 755 participants, of whom 371 (49.1%) were male; the mean (SD) age at baseline examination was 8.07 (2.00) years. In this cohort, 33 children (4.5%) had no sign of oral infections, whereas 41 (5.6%) had 1 sign, 127 (17.4%) had 2 signs, 278 (38.3%) had 3 signs, and 248 (34.1%) had 4 signs. The cumulative exposure to risk factors increased with the increasing number of oral infections both in childhood and adulthood. In multiple linear regression models, childhood oral infections, including signs of either periodontal disease (R2 = 0.018; P = .01), caries (R2 = 0.022; P = .008), or both (R2 = 0.024; P = .004), were associated with adulthood IMT. The presence of any sign of oral infection in childhood was associated with increased IMT (third tertile vs tertiles 1 and 2) with a relative risk of 1.87 (95% CI, 1.25-2.79), whereas the presence of all 4 signs produced a relative risk of 1.95 (95% CI, 1.28-3.00). The associations were more obvious in boys: if periodontal disease were present, the corresponding estimate was 1.69 (95% CI, 1.21-2.36); if caries, 1.46 (95% CI, 1.04-2.05); and if all 4 signs of oral infections, 2.25 (95% CI, 1.30-3.89). The associations were independent of cardiovascular risk factors.

Conclusions and relevance: Oral infections in childhood appear to be associated with the subclinical carotid atherosclerosis seen in adulthood.

Figure 1.. Atherosclerosis Risk Factors and Carotid Artery Intima-Media Thickness According to Number of Clinical Signs of Oral Infections

The numbers of observations in different years are as follows: A, systolic blood pressure (n = 727 in 1980, 639 in 1983, 563 in 1986, 470 in 2001, 472 in 2007); B, diastolic blood pressure (n = 726 in 1980, 634 in 1983, 563 in 1986, 470 in 2001, 472 in 2007); C, high-density lipoprotein cholesterol (HDLC) concentration (n = 725 in 1980, 626 in 1983, 559 in 1986, 474 in 2001, 475 in 2007); D, plasma glucose concentration (n = 548 in 1986, 474 in 2001, 476 in 2007); E, bod wheny mass index (n = 727 in 1980, 638 in 1983, 563 in 1986, 469 in 2001, 470 in 2007); and F, intima-media thickness (n = 468 in 2001, 489 in 2007). Mean (SE [error bars]) values and the statistical difference between the groups are shown.

Figure 2.. Cumulative Exposure to Atherosclerosis Risk Factors According to Number of Clinical Signs of Oral Infections

The risk factors are systolic and diastolic blood pressure; body mass index; and concentrations of glucose, triglycerides, high-density lipoprotein cholesterol, and low-desnity lipoportein cholesterol for childhood in 1980, 1983, and 1986, and for adulthood in 2001 and 2007. The area-under-the-curve variables for risk factors were dichotomized 1×1 into high-risk (≥75th percentile) and low-risk (<75th percentile) factor levels and then summed. Mean (SE [error bars]) values and statistically significant linear terms are shown.