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. 2024 Aug 31;3(10):101241.
doi: 10.1016/j.jacadv.2024.101241. eCollection 2024 Oct.

The Association Between Periodontal Disease and Cardiovascular Disease: Insights From Imaging, Observational, and Genetic Data

Mihir M Sanghvi  1   2 , Julia Ramírez  1   3   4 , Sucharitha Chadalavada  1   2 , Nay Aung  1   2 , Patricia B Munroe  1 , Nikolaos Donos  5 , Steffen E Petersen  1   2
Affiliations

The Association Between Periodontal Disease and Cardiovascular Disease: Insights From Imaging, Observational, and Genetic Data

Mihir M Sanghvi et al. JACC Adv. .

Abstract

Background: Periodontal disease is the sixth most common disease worldwide and may be a contributory risk factor for cardiovascular disease (CVD).

Objectives: This study utilizes noninvasive cardiac imaging and longitudinal and genetic data to characterize the association between periodontal disease and both cardiovascular magnetic resonance (CMR) imaging biomarkers of remodeling and incident coronary artery disease (CAD).

Methods: From the UK Biobank, 481,915 individuals were included, 91,022 (18.9%) of whom had self-reported periodontal disease. For imaging analysis, 59,019 had paired CMR data. Multivariable linear regression models were constructed to examine the association of periodontal disease on CMR outcomes. The endpoints for the CMR analyses were left ventricle (LV) end-diastolic volume, LV ejection fraction, LV mass, LV mass:volume ratio, LV global longitudinal strain, and native T1 values. The relationship between periodontal disease and CVD was assessed using Cox proportional hazards regression models, with incident CAD as the endpoint. To examine the relationship of genetically determined periodontal disease on CAD, a genome-wide polygenic risk score was constructed.

Results: Periodontal disease was associated with a significantly higher LV mass:volume ratio (effect size: 0.00233; 95% CI: 0.0006-0.004) and significantly lower T1 values (effect size: -0.86 ms; 95% CI: -1.63 to -0.09). Periodontal disease was independently associated with an increased hazard of incident CAD (HR: 1.09; 95% CI: 1.07-1.13) at a median follow-up time of 13.8 years. Each SD increase in the periodontal disease polygenic risk score was associated with increased odds of CAD (OR: 1.03; 95% CI: 1.02-1.05).

Conclusions: Using an integrated approach across imaging, observational, and genomic data, periodontal disease is associated with biomarkers of subclinical remodeling as well as incident CAD. These findings highlight the potential importance of periodontal disease in the broader context of CVD prevention.

Keywords: cardiovascular magnetic resonance; cardiovascular risk factors; coronary artery disease; periodontal disease.

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Conflict of interest statement

Dr Sanghvi recognizes his British Heart Foundation’s (BHF) Clinical Research Training Fellowship (FS/CRTF/22/24353). Dr Chadalavada is supported by the European Union's 10.13039/100010661Horizon 2020 research and innovation program under grant agreement no. 825903 (euCanSHare project). Dr Aung recognizes his 10.13039/501100000265Medical Research Council (MRC) Clinician-Scientist Award (MR/X020924/1). Drs Munroe and Petersen acknowledge the support of the National Institute for Health and Care Research Barts Biomedical Research Centre (NIHR203330), a delivery partnership of Barts Health NHS Trust, Queen Mary University of London, St George’s University Hospitals NHS Foundation Trust, and St George’s University of London. Dr Petersen acknowledges the British Heart Foundation for funding the manual analysis to create a cardiovascular magnetic resonance imaging reference standard for the UK Biobank imaging resource in 5,000 CMR scans (PG/14/89/31194). Barts Charity (G-002346) contributed to fees required to access UK Biobank data [access application #2964]. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
The Association of Self-Reported Periodontal Disease and Incident CAD Adjusted survival curves denoting risk of incident CAD from Cox proportional hazards model by presence of periodontal disease. Blue line represents those with self-reported periodontal disease, and yellow line represents those without. A total of 9,022 individuals are in the periodontal disease group, and 390,893 individuals are in the no periodontal disease group. Two-sided P value calculated using Cox proportional hazard models for association between periodontal disease and incident CAD and P value from log rank test used to compare distributions between the periodontal disease and no periodontal disease groups. CAD = coronary artery disease.
Figure 2
Figure 2
The Association of Genetically-Determined Periodontal Disease and CAD PRS for periodontal disease and risk of CAD stratified by entire cohort, top decile for PRS (dark blue shading) and bottom decile (light blue shading) for PRS. In the analysis, 467,350 individuals were included. Circles represent ORs, and error bars represent 95% CIs. CAD = coronary artery disease.
Central Illustration
Central Illustration
The Association Between Periodontal Disease and Cardiovascular Disease: Insights From Imaging, Observational, and Genetic Data Self-reported periodontal disease is associated with cardiac remodeling and incident coronary artery disease. For self-reported periodontal disease in a large-scale population-based study, there is evidence of association with markers of adverse, subclinical remodeling as measured by cardiovascular magnetic resonance imaging and with incident coronary artery disease on longitudinal follow-up (median 13.8 years). For genetically determined risk of periodontal disease as assessed by a polygenic risk score, there is association with significantly increased risk of coronary artery disease. CAD = coronary artery disease; CMR = cardiovascular magnetic resonance; GWAS = genome-wide association study.
See this image and copyright information in PMC

References

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