Periodontal Disease Association with Large-Artery Atherosclerotic Stroke

We investigated whether periodontal disease is associated with specific stroke subtype.

This is a single-center cross-sectional study. Periodontal disease was assessed in stroke and transient ischemic attack patients. Strokes caused by large-artery atherosclerosis were classified as intracranial atherosclerosis or extracranial atherosclerosis as well as anterior or posterior circulation disease.

Consecutive patients (N=265) were enrolled (age 64 ± 12.8, 49% white, 46% black, and 56% male). A third (N=87) had moderately severe periodontal disease. Twenty percent (N=42) were strokes due to large-artery atherosclerosis. Large-artery strokes had a higher proportion of patients with periodontal disease than without periodontal disease (31% vs.16%, X² p=0.01). There was also a higher proportion of patients with periodontal disease (12% vs. 5%) with stroke due to posterior circulation disease (crude odds ratio or OR 3.0, 95% CI 1.1-7.9, p=0.03), which persisted after adjustment for covariates (adjusted OR 3.1, 95% CI 1.04-9.1, p=0.004). Periodontal disease patients had a higher rate of large-artery stroke due to intracranial atherosclerosis compared to those without periodontal disease (20% vs. 8%; crude OR 2.6, 95% CI 1.3-5.6, p=0.01), and this association persisted after adjustment (adjusted OR 2.6, 95% CI 1.1-5.8, p=0.004).

We report a higher proportion of stroke due to large-artery atherosclerosis in patients with periodontal disease compared to those without periodontal disease. We report an independent association between periodontal disease and intracranial atherosclerosis, as well as between periodontal disease and posterior circulation disease.