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To the Editor: Dr Hujoel and colleagues¹ analyzed the First National Health and Nutrition Examination Survey (NHANES) I to assess the relationship between periodontal disease (PD) and coronary heart disease (CHD) and concluded that their study provided "convincing evidence regarding the absence of a moderate-to-large association . . ." between these 2 diseases. We believe that their conclusion about the lack of an association between PD and CHD is premature and unsubstantiated.

Several limitations in the NHANES I data may limit the apparent association between PD and CHD. First, the measure of periodontal disease in NHANES I is subjective and less accurate than objective measures like those used in NHANES III. Hence, misclassification of PD is likely. A longitudinal study² that used an objective measure of PD showed a strong association between PD and CHD in men.

A further limitation is that PD was measured at baseline only, and changes . . . [Full Text of this Article]

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