Relationship Between Periodontitis and Risk of Cardiovascular Disease: Insights from the Tromsø Study

Background: Few large-scale studies have investigated the association between periodontitis and cardiovascular risk estimated by risk assessment models; moreover, this association remains unexplored in never-smokers. We aimed to examine the relationship between periodontitis and cardiovascular risk in a Norwegian general population, with a focus on never-smokers and the impact of sex and age.

Methods: The present study included 2623 participants from the seventh survey of the Tromsø Study (Tromsø7, 2015-2016), aged 45-74 years, and without previous myocardial infarction or stroke. Periodontitis was defined according to the 2017 American Academy of Periodontology and the European Federation of Periodontology classification system. Participants were categorized by grade based on percentage bone loss/age as no periodontitis/Grade A (low progression rate) and Grade B/C (moderate-rapid progression rate). Low, medium, and high cardiovascular risk was defined based on the Norwegian risk model NORRISK 2. We used ordered logistic regression analysis to examine the association between periodontitis and cardiovascular risk, adjusting for education, toothbrushing frequency, body mass index, and diabetes. Subanalyses included stratification by sex and age (45-54, 55-64, 65-74 years) and a separate analysis of never-smokers.

Results: Periodontitis Grade B/C was associated with higher cardiovascular risk than no periodontitis/Grade A (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.75-2.61). This association was significant in both men and women, all age groups, and never-smokers. However, when never-smokers were stratified by age, the association remained significant only in those aged 65-74 years (OR, 3.00; 95% CI, 1.50-5.99).

Conclusion: Periodontitis Grade B/C was associated with higher cardiovascular risk overall, and in never-smokers aged 65-74 years.