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The First National Health and Nutrition Examination Survey and Its Follow-up Study

Tiejian Wu, MD, PhD; Maurizio Trevisan, MD, MS; Robert J. Genco, DDS, PhD; Joan P. Dorn, PhD; Karen L. Falkner, PhD; Christopher T. Sempos, PhD

Arch Intern Med. 2000;160:2749-2755.

Background  Periodontal disease has been found to be a potential risk factor for coronary heart disease. However, its association with cerebrovascular accidents (CVAs) is much less studied.

Methods  This study examines the association between periodontal disease and CVA. The study cohort comprises 9962 adults aged 25 to 74 years who participated in the First National Health and Nutrition Examination Survey and its follow-up study. Baseline periodontal status was categorized into (1) no periodontal disease, (2) gingivitis, (3) periodontitis, and (4) edentulousness. All CVAs (International Classification of Diseases, Ninth Revision [ICD-9], codes 430-438) were ascertained by hospital records for nonfatal events and death certificates for fatal events. The first CVA, nonfatal or fatal, was used to define incidence. Relative risks were estimated by hazard ratios from the Cox proportional hazard model with adjustment for several demographic variables and well-established cardiovascular risk factors. Weights were used to generate risk estimates.

Results  Periodontitis is a significant risk factor for total CVA and, in particular, nonhemorrhagic stroke (ICD-9, 433-434 and 436-438). Compared with no periodontal disease, the relative risks (95% confidence intervals) for incident nonhemorrhagic stroke were 1.24 (0.74-2.08) for gingivitis, 2.11 (1.30-3.42) for periodontitis, and 1.41 (0.96-2.06) for edentulousness. For total CVA, the results were 1.02 (0.70-1.48) for gingivitis, 1.66 (1.15-2.39) for periodontitis, and 1.23 (0.91-1.66) for edentulousness. Increased relative risks for total CVA and nonhemorrhagic stroke associated with periodontitis were also seen in white men, white women, and African Americans. Similar results were found for fatal CVA.

Conclusion  Periodontal disease is an important risk factor for total CVA and, in particular, nonhemorrhagic stroke.

From the Departments of Social and Preventive Medicine (Drs Wu, Trevisan, Dorn, and Falkner) and Oral Biology (Dr Genco), State University of New York at Buffalo; and the Office of Research on Minority Health, National Institutes of Health, Bethesda, Md (Dr Sempos).

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