Periodontal disease classifications and incident coronary heart disease in the Atherosclerosis Risk in Communities study

James D. Beck, Kamaira Philips, Kevin Moss, Souvik Sen, Thiago Morelli, John Preisser, James Pankow

Research output: Contribution to journalArticlepeer-review


Background: Periodontal disease has been linked to coronary heart disease (CHD), but studies have been inconclusive. This study investigates the link between periodontal disease and incident CHD. Methods: Baseline periodontal data from a full-mouth periodontal exam (N = 6,300) and CHD outcomes through 2017 were obtained from the Atherosclerosis Risk in Communities Study. Periodontitis was defined by the Periodontal Profile Class System adapted to Stages (PPC stages) and the Centers for Disease Control/American Academy of Periodontology (CDC/AAP) index. Competing risk models were used to determine hazard ratios (HR) for incident CHD, congestive heart failure (CHF), and other causes of death. Secondary analysis included myocardial infarction (MI) and fatal CHD. Results: Females comprised 56% of participants and males 44% with a combined mean age of 62.3 years (range: 52 to 74). Participants were followed for an average of 16.7 (SD: 5.5) years. In a fully adjusted model, PPC stage VII (Severe Tooth Loss) was moderately significantly related to incident CHD, (HR 1.51 [1.11 to 2.09]). PPC stage V (Mild Tooth Loss/High Gingival Inflammation) was significant for fatal CHD (HR, 5.27 [1.80 to 15.4]) and PPC stage VII was significant for incident MI (HR, 1.59 [1.13 to 2.23]). The CDC/AAP definition was not significantly associated with incident CHD. Conclusions: Incident CHD was moderately significantly associated with a specific stage of periodontal disease characterized by severe tooth loss, while none of the categories of the CDC/AAP were significantly associated. Thus, while periodontal therapy may improve oral health, it may be effective at impacting CHD incidence in only certain groups of people.

Original languageEnglish (US)
Pages (from-to)1409-1418
Number of pages10
JournalJournal of periodontology
Issue number11
StatePublished - Nov 2020

Bibliographical note

Funding Information:
The Atherosclerosis Risk in Communities study has been funded in whole or in part with Federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, under Contract nos. (HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700005I, HHSN268201700004I). The ARIC Dental Study was funded by NIH/NIDCR R01‐DE021418, and R01‐DE021986, and NIH/NCRR UL1‐TR001111.

Publisher Copyright:
© 2020 The Authors. Journal of Periodontology published by Wiley Periodicals LLC on behalf of American Academy of Periodontology


  • congestive heart failure
  • coronary heart disease
  • epidemiology
  • humans
  • incidence
  • incident disease
  • inflammation
  • myocardial infarction
  • periodontal disease
  • tooth loss

Fingerprint Dive into the research topics of 'Periodontal disease classifications and incident coronary heart disease in the Atherosclerosis Risk in Communities study'. Together they form a unique fingerprint.

Cite this