Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology
Oral MedicineMeta-analysis of periodontal disease and risk of coronary heart disease and stroke*,**,*,**,*,**,♦
Section snippets
Literature search
A search of Medline for all the published articles in the English language with coronary heart disease (CHD) or stroke or both as the outcome and periodontal disease as the predictor variable was performed in February 2001. The CVD search terms used were cerebrovascular disorders, cerebrovascular accident or stroke, cardiovascular diseases, or coronary heart disease. We combined these terms with periodontal diseases. Nine cohort studies were identified. In addition, several studies cited in the
Results
The details of the 9 studies involving 7035 cardiovascular events from the cohort of 107,011 individuals are shown in Table III.The test of publication bias was not significant (Begg's test, P =.18), suggesting that it is unlikely that some studies might have been chosen preferentially. Interreviewer reliability of data extraction was tested with percent agreement. The average correlation coefficient between the reviewers was 0.9. Quality evaluation was described by the percent of the maximum
Discussion
Our results suggest that periodontal disease may be significantly associated with CVD, although the increment of risk between subjects with or without periodontal disease in the general population is modest, at around 20%. However, because nearly 40% of the population has periodontal disease,6 this modest increase may have a profound public health impact. A significant and stronger association of periodontal disease with the incidence of CVD was observed among subjects aged 65 years or younger
Conclusion
Our results suggest that periodontal disease is associated with the increased risk of development of subsequent CVD by approximately 19% in the general population. However, this summary result might still underestimate the true risk increase. Because in some studies inadequate confounding adjustment resulted in an overestimate of the RR by 12.9% and use of questionnaires resulted in an underestimate of the RR by 29.7%, the net result is still lower than the true RR. Further research is needed
Acknowledgements
We thank Dr David Bellinger, The Children's Hospital, Harvard Medical School, Boston, Mass, for input into and comments on epidemiologic interpretations.
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Reprint requests: Sok-Ja Janket, DMD, MPH, Division of Preventive Medicine, Harvard Medical School, 900 Commonwealth Ave East, Boston, MA 02215-1204, [email protected]
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Views expressed in this article are those of the authors and do not represent those of the Department of Veterans Affairs.
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aFellow, VA Medical Center, Dental Service, Bedford, Mass; Harvard School of Public Health, Boston, Mass.
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bChief, Stroke Neuroscience Unit, National Institute of Neurological Disorders and Stroke, NIH, Bethesda, Md.
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cInstructor, Harvard School of Public Health, Boston, Mass; Harvard School of Dental Medicine, Boston, Mass.
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dChief, Outcomes Section, VA Center for Health Quality, Outcomes, & Economic Research, Bedford, Mass; Associate Professor and Chair of General Dentistry, Boston University Goldman School of Dental Medicine and School of Public Health, Boston, Mass.
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