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Philippe P. Hujoel, PhD; Mark Drangsholt, DDS, MPH; Charles Spiekerman, PhD; Timothy A. DeRouen, PhD

JAMA. 2000;284:1406-1410.

Context  Research has suggested a relationship between periodontal disease and coronary heart disease (CHD), but data on the association between these 2 common conditions are inconclusive due to the possibility of confounding.

Objective  To evaluate the risk of CHD in persons with periodontitis, gingivitis, or no periodontal disease.

Design  Prospective cohort study.

Setting  The First National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, conducted in 1982-1984, 1986, 1987, and 1992.

Participants  A total of 8032 dentate adults aged 25 to 74 years with no reported history of cardiovascular disease, including 1859 individuals with periodontitis, 2421 with gingivitis, and 3752 with healthy periodontal tissues.

Main Outcome Measure  First occurrence of death from CHD or hospitalization due to CHD, or revascularization procedures, obtained from death certificates and medical records, by baseline periodontal status.

Results  During follow-up, 1265 individuals had at least 1 CHD event, including CHD fatality (n = 468) or at least 1 hospitalization with a diagnosis of CHD (n = 1022), including coronary revascularization procedures (n = 155). After adjustment for known cardiovascular risk factors, gingivitis was not associated with CHD (hazard ratio, 1.05; 95% confidence interval, 0.88-1.26), while periodontitis was associated with a nonsignificant increased risk for CHD event (hazard ratio, 1.14; 95% confidence interval, 0.96-1.36).

Conclusion  This study did not find convincing evidence of a causal association between periodontal disease and CHD risk.

Author Affiliation: Department of Dental Public Health Sciences, School of Dentistry (Drs Hujoel, Drangsholt, Spiekerman, and DeRouen), Department of Epidemiology, School of Public Health (Dr Hujoel), Department of Oral Medicine, School of Dentistry (Dr Drangsholt), Department of Biostatistics, School of Public Health (Dr DeRouen), and Department of Medicine, Cardiovascular Health Research Unit (Dr Spiekerman), University of Washington, Seattle.

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