Coronary Artery Disease
Comparison of Frequency and Duration of Periodontal Disease With Progression of Coronary Artery Calcium in Patients With and Without Type 1 Diabetes Mellitus

https://doi.org/10.1016/j.amjcard.2015.06.006Get rights and content

People with type 1 diabetes mellitus manifest a greater burden of both periodontal disease and coronary artery disease (CAD); however, little is known about their interrelation. Coronary artery calcium (CAC) measures subclinical atherosclerosis and predicts major adverse coronary events. The relation between periodontal disease and CAC progression in individuals with type 1 diabetes has not been previously described. We determined the prevalence and progression of CAC in relation to self-reported periodontal disease. Multivariate logistic and tobit regression models were used to examine the relation between periodontal disease duration and CAC progression and whether this relation differs by diabetes status after controlling for age, gender, total and high-density lipoprotein cholesterol, hypertension, smoking, body mass index (BMI), duration of diabetes, and baseline CAC. A total of 473 patients with type 1 diabetes and 548 without diabetes were followed for a mean of 6.1 years. At baseline, the prevalence and duration of periodontal disease did not differ between subjects with and without diabetes (14.5% vs 13.4%, p = 0.60; 6 vs 9 years, p = 0.18). Duration of periodontal disease was not significantly associated with baseline CAC prevalence. In patients with type 1 diabetes, periodontal disease duration was significantly related to CAC progression (p = 0.004) but not in subjects without diabetes (p = 0.63). In conclusion, this study suggests that periodontal disease is an independent predictor of long-term progression of CAC in patients with type 1 diabetes.

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Methods

Subjects were identified from the CACTI Study. CACTI is a prospective cohort study examining the prevalence of CAC in patients with type 1 diabetes and a comparable group of controls with no history of atherosclerotic cardiovascular disease. Detailed descriptions of the study design have previously been published.2 Participants in this study included those who had completed the 6-year (range 4.1 to 8.5 years) follow-up visit and had complete data for all covariates (n = 1,021). Informed consent

Results

A total of 473 patients with established type 1 diabetes and 548 nondiabetic individuals were assessed. Participant characteristics at baseline stratified by diabetes status are presented in Table 1. Those patients with diabetes were younger and more likely to be receiving medications for hypertension and dyslipidemia. Corresponding diastolic blood pressure, total cholesterol, LDL cholesterol, and triglycerides were lower in those with diabetes compared to those without diabetes. Gender,

Discussion

Patients with type 1 diabetes are at increased risk for the development of both periodontal disease and CAD, but the interrelation between these conditions is not fully understood. Given the longitudinal nature of the study, we further investigated the relation between diabetes and periodontal disease on the progression of CAC over a 6-year period. Although periodontal disease did not differ at baseline between the diabetic and nondiabetic groups, the duration of periodontal disease was

Disclosures

The authors have no conflicts of interest to report.

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