Severe Periodontitis Flags Hidden Coronary Risk

Clinical question: is periodontitis mechanistically linked to coronary heart disease (CHD) through subclinical atherosclerosis, and does it associate with inflammation in epicardial adipose tissue (EAT)?

Methodology: the Swedish CArdioPulmonary bioImage Study (SCAPIS) linked dental register data to national CHD incidence records for 29,056 participants. Coronary atherosclerosis was quantified with coronary artery calcium scores (CACS) and segment involvement scores (SIS) from cardiac CT; EAT attenuation, a marker of local inflammatory activity, was derived from the same non-contrast scans. Multivariable regression and mediation analysis tested whether coronary atherosclerosis explained the periodontitis-CHD association.

Findings: severe periodontitis was present in 6% of participants (n=1,809) and was associated with severe CACS (OR 1.69) and higher SIS (OR 1.40), with the strongest associations in patients without concomitant dental caries. Periodontitis was also associated with lower EAT attenuation, indicating greater local inflammatory activity, and with a 42% higher hazard of incident CHD events (HR 1.42) — an association partially mediated by coronary atherosclerosis.

Clinical relevance: this large, register-linked cohort adds mechanistic weight to the periodontitis-cardiovascular disease connection, positioning severe periodontitis as a marker of elevated coronary risk that warrants closer cardiovascular risk assessment and closer collaboration between periodontists and cardiologists.