Age-Dependent Associations Between Chronic Periodontitis/Edentulism and Risk of Coronary Heart Disease

This research was originally published in 2008 by Thomas Dietrich, DMD, MD, MPH; Monik Jimenez, SM; Elizabeth A. Krall Kaye, MPH, PhD; Pantel S. Vokonas, MD And Raul I. Garcia, DMD, MMSc.

We have curated this article as a reference point for The Larkin Protocol.


Several epidemiological studies have suggested periodontitis as a risk factor for coronary heart disease (CHD), but results have been inconsistent.

Methods and Result

We evaluated the association between clinical and radiographic measures of periodontitis, edentulism, and incident CHD (angina, myocardial infarction, or fatal CHD) among 1203 men in the VA Normative Aging and Dental Longitudinal Studies who were followed up with triennial comprehensive medical and dental examinations up to 35 years (median 24 years). Cox proportional hazards models with time-varying effects of exposure and potential confounders were fit. We found a significant dose-dependent association between periodontitis and CHD incidence among men 60 years of age (hazard ratio 2.12, 95% confidence interval 1.26 to 3.60 comparing highest versus lowest category of radiographic bone loss, P for trend0.02), independent of age, body mass index, smoking, alcohol intake, diabetes mellitus, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, hypertension, systolic and diastolic blood pressure, education, marital status, income, and occupation. No association was found among men 60 years of age. Similar results were found when the sum of probing pocket depths was used as a measure of periodontitis. Among men 60 years of age, edentulous men tended to have a higher risk of CHD than dentate men in the lowest bone loss (hazard ratio 1.61, 95% confidence interval 0.95 to 2.73) and lowest pocket depth (hazard ratio 1.72, 95% confidence interval 1.03 to 2.85) categories, independent of confounders.


Chronic periodontitis is associated with incidence of CHD among younger men, independent of established cardiovascular risk factors. (Circulation. 2008;117:1668-1674.)

Key Words: coronary disease  epidemiology  infection  inflammation  risk factors


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