An examination of the risk of periodontitis for nonfatal cardiovascular diseases on the basis of a large insurance claims database

Objectives Although many studies have reported a higher risk of atherosclerotic cardiovascular diseases (ACVD) in people with periodontitis (PD), this has been tested in a few large-scale population-based studies with a longitudinal design. The aim of this study was to investigate whether people with PD status have an increased risk of a nonfatal ACVD event compared to people without PD status. Methods A cohort of 1.2 million participants from a healthcare insurance claims database was studied longitudinally for a period of 8 years. PD status was derived from PD-related insurance claims and ACVD status from ACVD-related insurance claims. Person-time at risk (PTAR) was calculated from the start of follow-up (01 January 2007) for participants with and without PD status until ACVD or event-free censoring (31 December 2014). Time-dependent Cox proportional hazard models were used to calculate the hazard ratio (HR) and to adjust for shared risk factors (age, sex, socioeconomic position and diabetes mellitus). Results The prevalence of PD was 20.1%, and the cumulative incidence of nonfatal ACVD events was 7.5%. The univariable and multivariable analyses revealed a limited risk of ACVD for participants with PD status (HR: 1.12; 95% CI 1.10-1.14, HR: 1.06; 95% CI 1.04-1.08, respectively). A subgroup analysis of participants <= 35 and > 35 years of age showed that those <= 35 years of age with PD status had a higher ACVD risk (univariable HR: 1.20; 95% CI 1.05-1.37, multivariable HR: 1.21; 95% CI 1.05-1.39). ACVD risk was not increased in participants >35 years of age with PD status (univariable HR: 0.92; 95% CI 0.91-0.94, multivariable HR: 0.96; 95% CI 0.94-0.98). Conclusions This study based on a healthcare insurance cohort shows that PD can hardly be regarded as a risk factor for nonfatal ACVD. The increased risk is of minor size, and therefore, the proposed role of PD in the development of ACVD events should be reconsidered. Possibly PD plays a role as a risk factor in younger people due to overlapping genetic risk factors of ACVD and a more aggressive course of PD.