Association Between Personal and Family History of Cardiovascular Disease and Periodontal Interproximal Clinical...

Periodontitis and cardiovascular disease (CVD) are chronic inflammatory conditions that share several common risk factors, including smoking, diabetes, and socioeconomic factors. Previous studies have reported associations between periodontal disease and cardiovascular outcomes; however, most investigations have relied on composite periodontal case definitions. Interproximal clinical attachment loss (iCAL) represents a direct clinical indicator of cumulative periodontal destruction. This study aimed to investigate the association between personal and family history of CVD and periodontal attachment loss using nationally representative data from the United States.

The National Health and Nutrition Examination Survey (NHANES) 2009-2014 data were analyzed. Adults ≥30 years with full-mouth periodontal examinations were included. Periodontal status was assessed using maximal iCAL, categorized as 0-2, 3-4, 5-6, and ≥7 mm. Personal history of CVD included self-reported myocardial infarction, coronary heart disease, congestive heart failure, or angina. Survey-weighted multivariable logistic regression evaluated associations between iCAL and personal or family history of CVD, adjusting for age, sex, race/ethnicity, body mass index (BMI), smoking status, education, income-to-poverty ratio, and remaining teeth. Personal and family history of CVD were analyzed in separate samples due to differing covariate completeness.

A total of 11,675 participants (personal CVD analysis) and 11,460 (family history analysis) were included. Participants with a personal history of CVD were older, had higher BMI, and fewer remaining teeth. In survey-weighted models, iCAL 5-6 mm was associated with personal CVD history both before and after full adjustment (odds ratio (OR), 1.56; 95% confidence interval (CI), 1.04-2.34; p = 0.032); iCAL 7+ mm attenuated to nonsignificance after full adjustment (OR, 1.47; 95% CI, 0.97-2.23; p = 0.065). Family history of CVD was associated with greater tooth loss (OR, 1.29; 95% CI, 1.07-1.55) and having ≤20 remaining teeth (OR, 1.27; 95% CI. 1.06-1.51; p = 0.010), but not with edentulism (OR, 1.39; 95% CI, 0.94-2.05; p = 0.100) or periodontal attachment loss (OR, 1.09; 95% CI, 0.92-1.31) after weighting. All analyses were survey-weighted using NHANES design variables merged from the demographics files.

Personal history of CVD was independently associated with moderate periodontal attachment loss (iCAL 5-6 mm) after full adjustment, while the most severe category attenuated to nonsignificance. Family history of CVD was associated with tooth loss but not directly with periodontal attachment loss. Given the cross-sectional design, causal interpretation is not warranted; longitudinal studies are needed to clarify these relationships.