Holmlund A, Lampa E, Lind L
1 Department of Periodontology, County Hospital of Gävle; Center for Research and Development, Uppsala University/Region of Gävleborg, Gävle, Sweden.
2 Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
J Dent Res. 2017 Jul;96(7):768-773. doi: 10.1177/0022034517701901. Epub 2017 Mar 31.
Periodontal disease has been associated with cardiovascular disease (CVD), but whether the response to the treatment of periodontal disease affects this association has not been investigated in any large prospective study. Periodontal data obtained at baseline and 1 y after treatment were available in 5,297 individuals with remaining teeth who were treated at a specialized clinic for periodontal disease. Poor response to treatment was defined as having >10% sites with probing pocket depth >4 mm deep and bleeding on probing at ≥20% of the sites 1 y after active treatment. Fatal/nonfatal incidence rate of CVD (composite end point of myocardial infarction, stroke, and heart failure) was obtained from the Swedish cause-of-death and hospital discharge registers. Poisson regression analysis was performed to analyze future risk of CVD. During a median follow-up of 16.8 y (89,719 person-years at risk), those individuals who did not respond well to treatment (13.8% of the sample) had an increased incidence of CVD ( n = 870) when compared with responders (23.6 vs. 15.3%, P < 0.001). When adjusting for calendar time, age, sex, educational level, smoking, and baseline values for bleeding on probing, probing pocket depth >4 mm, and number of teeth, the incidence rate ratio for CVD among poor responders was 1.28 (95% CI, 1.07 to 1.53; P = 0.007) as opposed to good responders. The incidence rate ratio among poor responders increased to 1.39 (95% CI, 1.13 to 1.73; P = 0.002) for those with the most remaining teeth. Individuals who did not respond well to periodontal treatment had an increased risk for future CVD, indicating that successful periodontal treatment might influence progression of subclinical CVD.
牙周疾病与心血管疾病（CVD）有关，但在任何大型前瞻性研究中，都尚未对牙周疾病治疗反应是否会影响这种关联进行调查。在一家专门的牙周疾病诊所接受治疗的5297名有剩余牙齿的个体中，可获取基线时和治疗后1年的牙周数据。治疗反应不佳被定义为在积极治疗1年后，有超过10%的位点探诊袋深度>4mm且≥20%的位点探诊出血。CVD的致命/非致命发病率（心肌梗死、中风和心力衰竭的综合终点）来自瑞典死因和医院出院登记册。进行泊松回归分析以分析CVD的未来风险。在中位随访16.8年（89719人年的风险期）期间，与治疗反应良好者相比，治疗反应不佳者（占样本的13.8%）的CVD发病率增加（n = 870）（23.6%对15.3%，P < 0.001）。在调整日历时间、年龄、性别、教育水平、吸烟以及探诊出血、探诊袋深度>4mm和牙齿数量的基线值后，治疗反应不佳者的CVD发病率比为1.28（95%CI，1.07至1.53；P = 0.007），而反应良好者则相反。对于剩余牙齿最多的人，治疗反应不佳者的发病率比增加到1.39（95%CI，1.13至1.73；P = 0.002）。对牙周治疗反应不佳的个体未来患CVD的风险增加，这表明成功的牙周治疗可能会影响亚临床CVD的进展。
