| Summary: | 博士 === 國立陽明大學 === 公共衛生研究所 === 102 === Background:
The periodontal disease (PD) is a high prevalent disease around the world. The cardiovascular diseases (CVD) are the common diseases of modern people and result in high mortality rates. Cardiovascular disease included myocardial infarction, angina, stroke, transient ischemic attack, claudication, heart failure, coronary revascularization and peripheral arterial disease is the major death cause and leads severe disability. Acute myocardial infarction (AMI) is the leading cause of morbidity and mortality worldwide. AMI is one of the acute events of CHD and may result in sudden death or disability. The risk factors of CHD include age, male gender, hypertension, diabetes, dyslipidemia, smoking, as well as inflammatory disease such as periodontal disease (PD).
A correlation has been established between periodontal disease and cardiovascular diseases. However, no previous studies have discussed the relationship between different PD treatments and the incidence rate of cardiovascular diseases among different age groups.
The Longitudinal Health Insurance Database (LHID) from National Health Insurance Research Database (NHIRD) in Taiwan provided information of representative samples in Taiwan. Our research explores the association between PD and cardiovascular diseases including ischemic stroke and AMI after adjust the age, gender, and comorbidities through analyzing the registry data of the population in Taiwan. The observation focus on whether different PD treatments result in different incidence of stroke and AMI.
Methods:
Two parts of our research were both designed as population-based retrospective cohort studies. A million registered beneficiaries of the NHI program in Taiwan were randomly selected in 2000. All claims for reimbursements and registry files from 2000 to 2010 were used for analysis.
We identified 510 762 PD cases and 208 674 non-PD subjects from January 1, 2000 to December 31, 2010 from the Taiwanese NHIRD administrative data included in the study of PD and ischemic stroke. And of total 511 630 PD cases and 208 713 non-PD subjects were included in the study of PD and AMI. The PD cases were divided into dental prophylaxis, intensive treatment, and PD without treatment groups. The ischemic stroke incidence rates (stroke-IR) and AMI incidence rates (AMI-IR) were assessed among groups during follow-up in the two parts of our research. Cox regression analysis was used to determine the relationship between PD and incidence of ischemic stroke and AMI after adjustment for age, sex, and comorbidities in our research.
Results:
From the finding of our first part of research: the stroke- IR of the non-PD was 0.32%/y. In the PD group, subjects who received dental prophylaxis had the lowest stroke- IR (0.14%/y); subjects with intensive PD treatment or tooth extraction had a higher stroke- IR (0.39%/y); and subjects without PD treatment had the highest stroke- IR (0.48%/y) (p< 0.001). After adjustment for confounders, the dental prophylaxis and intensive treatment groups had a significant lower Hazard Ratio (HR) for ischemic stroke than non- PD group (HR=0.78 and 0.95, 95%CI =0.75-0.81 and 0.91-0.99, respectively), whereas the PD without treatment group had a significant higher HR for stroke (HR=1.15, 95%CI=1.07-1.24), especially among the youngest (20-44) age group (HR=2.17, 95%CI =1.64-2.87) after stratifying for age.
The results of our second part of research showed the AMI-IR for non-PD group was 0.19%/y. In contrast, for the PD group undergoing dental prophylaxis exhibited the lowest AMI-IR (0.11%/y) while subjects applied for intensive treatment and without PD treatment had higher AMI-IR with 0.28%/y and 0.31%/y, respectively (p<0.001). Interestingly, the significant trend relationship of AMI-IR among three PD treatment groups (dental prophylaxis< intensive treatment < without treatment group) was found among all age-, sex-, and comorbidity group. And the dental prophylaxis group had a lower HR for AMI compared to non-PD group (HR=0.89, 95%CI =0.85-0.94) whereas the PD without treatment group had the higherst HR (1.24, 95%CI=1.13-1.36) among all PD groups after adjustment for confounders.
Conclusion:
The dental prophylaxis is a protective factor for both ischemic stroke and AMI. Maintaining periodontal health by receiving dental prophylaxis and PD treatments could decrease the risk of ischemic stroke and AMI.
Significance:
The results of our research provide more information about the association between PD and cardiovascular diseases for clinicians and policy makers to emphasize the importance of oral hygiene and, hopefully, reduce the incidence rates of ischemic stroke and AMI result from PD of people.
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