No Significant Association Between Severity of Periodontal Disease and Recurring Ischemic Strokes/ Transient Ischemic Attacks

In a recent publication, in the journal Cureus, researchers sought to ascertain if there was a correlation between the incidence of recurring vascular events and periodontal disease (PD). They also attempted to establish the severity of the periodontal disease among patients who had an ischemic stroke/TIA.

Researchers conducted a prospective, longitudinal, hospital-based cohort study involving 153 participants. The study participants all had a history of a prior stroke or transient ischemic attack (TIA). Researchers grouped the study participants into two cohorts: 55 subjects with moderate to severe periodontal disease were classified as having high periodontal disease (HPD), and 98 participants with mild periodontal disease were classified as having low periodontal disease (LPD). The average ages of participants in the two groups were 59.40±12.21 and 53.03±12.82, respectively.

To measure and examine the severity of the periodontal disease (PD), researchers employed the use of clinical attachment loss (CAL) and probing pocket depth (PPD). Additionally, the researchers utilized Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria to ascertain information about the cause of ischemic stroke. To establish the severity of the stroke, researchers employed the NIH Stroke Scale (NIHSS) and conducted tests to screen and monitor progression of periodontal disease and routinely observed patients for recurring vascular events.

Patients were queried about vascular risk factors, use of medications, dental care including frequency of receiving professional dental care and their self-care measures. Researchers conducted monthly phone calls for an average of 12 months to monitor patients for the occurrence of vascular events and to inquire about the well-being of study participants. During phone calls, the participants were queried about any occurrences of myocardial infarctions, recurrent stroke/TIA, emergency visits, hospital admissions, and outpatient procedures. Any deaths and the causes were also documented for trial data.

Results indicated that about three months post study enrollment, 38 subjects had a vascular event , including three fatalities due to a vascular event, thirty cerebrovascular events (23 strokes and seven TIAs), and five myocardial infarctions.

With regard to the patients in the HPD group, (43.6%) of patients with a severe form of periodontitis had vascular events, including twenty with cerebrovascular events that involved 15 strokes and five TIAs, two myocardial infarctions, and two vascular fatalities. Additionally, over the same follow-up period, results indicated that among the patients with a moderate form of periodontitis, (45.1%) had vascular events, including ten strokes/TIA, three myocardial infarctions, and one vascular fatality.

The authors wrote, “The results indicate that stroke patients were more likely to have a severe form of periodontal disease (PD) than TIA patients (62.5% vs. 20.8%). Patients with HPD were more likely to develop large vessel disease (LVD) than those with LPD, although the percentages of stroke subtypes did not seem to change (55% vs. 7.5%).”

Additionally, they wrote, “ There was a non-significant association between PD and composite vascular events (HR 1.06, 95% CI, 1.03 to 1.09, p=0.71). Compound vascular events were not related to severe HPD (HR 1.31, 95 % CI 0.54 to 3.16, p=0.07).”

The primary limitation of this study that was noted was the small sample size.  The authors concluded that among those individuals who have had a stroke/TIA, there is no correlation between moderate and severe periodontal disease and recurrent vascular episodes.

The authors wrote, “Stroke/TIA patients have more probability of suffering from an advanced form of periodontal disease. After correcting for potential confounding variables, no association could be identified between periodontal disease and a composite of vascular events. For stroke/TIA victims, periodontal disease did not affect the recurrence rate of vascular events. The proportions of different types of stroke were virtually identical.”

Reference

Sharma A, Sharma A, Chauhan R, et al. (March 22, 2023) The Relationship Between Periodontal Disease (PD) and Recurrent Vascular Events in Ischemic Stroke/Transient Ischemic Attack (TIA) Patients: A Hospital-Based Cohort Study. Cureus 15(3): e36530. doi:10.7759/cureus.36530