The Extent of Severe Periodontal Disease as a Predictor of Cardiovascular Complications and Mortality in Type 1 Diabetes (T1D)

This analysis was based on 320 participants (mean age=32.1 years and duration=23.7 years) of the Pittsburgh Epidemiology of Diabetes Complications study of childhood-onset (<17 years) T1D, who during 1992-94 received a comprehensive oral health exam including periodontal assessment of three facial sites (mesial, mid-cervical and distal) of the right maxillary/left mandibular or left maxillary/right mandibular quadrants and who were subsequently followed for up to 19 years to ascertain complication incidence. PD was defined as clinical attachment loss of ≥4 mm for at least 10% of the examined sites. Predictors of all-cause mortality; Hard Coronary Artery Disease (HCAD; CAD death, myocardial infarction or revascularization); and Coronary Artery Disease (CAD; HCAD but also including angina and ischemic ECG) were assessed using Cox models. In multivariable models, PD was not significantly associated with all-cause mortality (HR=1.07, 95% CI=0.48-2.37) although it was a significant predictor of both HCAD (HR=1.27, 95% CI=1.09-1.48) and CAD (HR=1.07, 95% CI=1.02-1.14). As smoking status was identified as a significant effect modifier of the PD-CAD and PD-HCAD associations, analyses were also conducted stratifying by smoking status. PD was associated with an increased risk of HCAD (HR=2.13, 95% CI= 1.26-3.61) and CAD (HR=1.27, 95% CI 1.05-1.53) only among smokers, whereas no relationship was observed among non-smokers (CAD HR=1.08, 95% CI=0.83-1.40; HCAD HR=1.18, 95% CI=0.83-1.69). PD was a significant predictor of HCAD and CAD among smokers with T1D.