June 06, 2019
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Periodontal disease increases CAD risk in smokers with type 1 diabetes

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Periodontal disease increases the risk for coronary artery disease among adults with type 1 diabetes who smoke, according to findings published in the Journal of Diabetes and its Complications.

“The importance of this research relates to the scarcity of data relating to periodontal disease and its effect on cardiovascular health among people with type 1 diabetes, whose risk of cardiovascular disease is already increased compared with the general population,” Tina Costacou, PhD, an associate professor of epidemiology at the University of Pittsburgh, told Endocrine Today. “These data suggest that in addition to good glycemic control and treatment of high blood pressure and cholesterol, smoking cessation and oral health are important factors in reducing the development of heart disease.”

Costacou and colleagues performed follow-up assessments in October 2014 with 320 adults with type 1 diabetes who took part in the Pittsburgh Epidemiology of Diabetes Complications study and underwent an oral health examination between 1992 and 1994. The researchers used data from the original examination to confirm diagnoses of periodontal disease, with 34 participants presenting with the condition (mean age, 37.61 years; 35.29% women) while 286 did not (mean age, 31.47 years; 45.45% women). Participants indicated that they currently smoked at baseline via questionnaire.

According to the researchers, 33.7% of the cohort had CAD at follow-up, and 46.4% of those who reported as current smokers during the initial examination had CAD after follow-up. Rates for hard CAD (CAD death, myocardial infarction) were 27.3% and 42.7% among the total cohort and the smoking cohort, respectively.

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Periodontal disease increases the risk for coronary artery disease among adults with type 1 diabetes who smoke.
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Compared with those without periodontal disease, participants with the condition were more likely to develop both CAD (HR = 1.11; 95% CI, 1.01-1.23) and hard CAD (HR = 1.24; 95% CI, 1.08-1.43).

The researchers noted that being a smoker influenced the association between periodontal disease and both CAD (P < .01) and hard CAD (P < .001). In fact, the risk for CAD (HR = 1.29; 95% CI, 1.07-1.56) and hard CAD (HR = 1.93; 95% CI, 1.23-3.05) was elevated for those with periodontal disease compared with those without the condition among smokers, but the significance was lost for those who did not smoke.

“Patients can be unaware of periodontal problems until the disease progresses to an advanced stage, which could increase their risk of CAD,” the researchers wrote. “Therefore, patients with [type 1 diabetes] should be advised by their health care providers that [periodontal disease], in addition to smoking, places them at increased risk of [cardiovascular disease] complications beyond the traditional risk factors. These patients should be referred to a periodontist and placed on a periodontal treatment regimen.” – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.