Cardiovascular Disease Detection in Dental Settings-Development and External Validation of a Nomogram (PerioCARD)

Cardiovascular disease (CVD) is a leading cause of mortality and morbidity worldwide. Since many people visit their dentists regularly, assessing CVD in dental settings offers valuable opportunities for its early detection. This study aims to identify easily accessible indicators in dental settings that are associated with CVD in adults and to develop a nomogram, providing a practical tool to integrate CVD case detection into routine dental care.

Demographic (age and sex), self-reported history (smoking, high cholesterol, diabetes, and use of hypertension medications), and periodontal data from the 2009 to 2010 National Health and Nutrition Examination Survey (NHANES) were utilized as candidate predictors for model training, targeting self-reported history of CVD as the reference standard. Multivariable logistic regression models were assessed using receiver operating characteristic analysis and calibration curves. The nomogram was internally validated with bootstrapping and externally validated (NHANES 2011-2012; 2013-2014) and assessed for discrimination and calibration.

Two thousand eight hundred and ninety participants were selected for training and 7416 for external validation. The final model, PerioCARD (Periodontal-based Cardiovascular Assessment and Recognition of Disease), included age, sex, smoking, high cholesterol, use of hypertensive medications, and periodontal status. The nomogram model achieved an area under the curve (AUC) of 0.82 (95% CI: 0.80-0.84) for identifying CVD, with an area under the precision-recall curve (AUPRC) of 0.38 (95% CI: 0.34-0.43). The external validation set had an AUC of 0.82 (95% CI: 0.81-0.84) and AUPRC of 0.32 (95% CI: 0.30-0.36), with good calibration and clinical net benefits in decision curve analysis.

The PerioCARD nomogram was developed and validated using accessible parameters in the dental chair. This may have practical implications for rapid case detection of individuals with CVD by dental professionals.