The Association of Periodontitis and Peripheral Arterial Occlusive Disease in a Prospective Population-Based Cross-Sectional Cohort Study

Nicole Jacobi, Carolin Walther, Katrin Borof, Guido Heydecke, Udo Seedorf, Ragna Lamprecht, Thomas Beikler, Sebastian E Debus, Christoph Waldeyer, Stefan Blankenberg, Renate B Schnabel, Ghazal Aarabi, Christian-Alexander Behrendt, Nicole Jacobi, Carolin Walther, Katrin Borof, Guido Heydecke, Udo Seedorf, Ragna Lamprecht, Thomas Beikler, Sebastian E Debus, Christoph Waldeyer, Stefan Blankenberg, Renate B Schnabel, Ghazal Aarabi, Christian-Alexander Behrendt

Abstract

Objectives: Peripheral arterial occlusive disease (PAOD) and periodontitis are common chronic diseases, which together affect almost 1 billion people worldwide. There is growing evidence suggesting a relationship between chronic inflammatory conditions such as periodontitis and PAOD. This study aims to determine an association between both entities using high quality research data and multiple phenotypes derived from an epidemiological cohort study.

Design: This population-based cross-sectional cohort study included data from 3271 participants aged between 45 and 74 years enrolled in the Hamburg City Health Study (NCT03934957).

Material & methods: An ankle-brachial-index below 0.9, color-coded ultrasound of the lower extremity arteries, and survey data was used to identify participants with either asymptomatic or symptomatic PAOD. Periodontitis data was collected at six sites per tooth and included the probing depth, gingival recession, clinical attachment loss, and bleeding on probing index. Multivariate analyses using logistic regression models were adjusted for variables including age, sex, smoking, education, diabetes, and hypertension.

Results: The baseline characteristics differed widely between participants neither affected by periodontitis nor PAOD vs. the group where both PAOD and severe periodontitis were identified. A higher rate of males, higher age, lower education level, smoking, diabetes, and cardiovascular disease was observed in the group affected by both diseases. After adjusting, presence of severe periodontitis (odds ratio 1.265; 97.5% CI 1.006-1.591; p = 0.045) was independently associated with PAOD.

Conclusion: In this cross-sectional analysis of a prospective cohort study, an independent association between periodontitis and PAOD was revealed. The results of the current study emphasize a potential for preventive medicine in an extremely sensitive target population. Future studies should determine the underlying factors modifying the relationship between both diseases.

Keywords: ankle brachial index; cardiovascular disease; cohort studies; diabetes; health services research; periodontitis; peripheral arterial disease; population health; risk factors; smoking.

Conflict of interest statement

RBS has received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme under the grant agreement No 648131, from the European Union’s Horizon 2020 research and innovation programme under the grant agreement No 847770 (AFFECT-EU) and German Center for Cardiovascular Research (DZHK e.V.) (81Z1710103); German Ministry of Research and Education (BMBF 01ZX1408A) and ERACoSysMed3 (031L0239). RBS has received lecture fees and advisory board fees from BMS/Pfizer outside this work. CAB has received funding from the German Federal Joint Committee under the grant agreement No 01VSF18035 and No 01VSF16008. The other authors declare no conflicts of interest related to the current research project.

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