scholarly journals Periodontal disease and incident venous thromboembolism: The Atherosclerosis Risk in Communities study

2018 ◽  
Vol 46 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Logan T. Cowan ◽  
Kamakshi Lakshminarayan ◽  
Pamela L. Lutsey ◽  
Aaron R. Folsom ◽  
James Beck ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Periodontal Disease ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk

Abstract 47: Atrial Fibrillation is Associated With Increased Risk of Incident Venous Thromboembolism: The Atherosclerosis Risk in Communities Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Pamela L Lutsey ◽  
Faye L Norby ◽  
Alvaro Alonso ◽  
Mary Cushman ◽  
Lin Y Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Venous Thromboembolism ◽  
Incidence Rate ◽  
Case Reports ◽  
Time Dependent ◽  
Atherosclerosis Risk In Communities ◽  
Increased Risk ◽  
Atherosclerosis Risk ◽  
Shared Risk

Background: It is well-established that atrial fibrillation (AF) is associated with thrombus formation in the left atrium, which can lead to ischemic stroke. Case reports, autopsies, and transesophageal echo data have indicated that clot formation also occurs in the right atrium (i.e. right-side intracardiac thrombosis) of AF patients, which could lead to pulmonary embolism (PE). However, it is unclear whether this occurrence is common. Objective: Test the hypotheses that individuals with incident AF are at elevated risk of developing venous thromboembolism (VTE), and that the association will be stronger for those presenting with PE alone versus PE and deep vein thrombosis (DVT) or DVT alone. Methods: A total of 15,205 Atherosclerosis Risk in Communities (ARIC) study participants, aged 45-64 years, were followed from baseline (1987-1989) to 2011 for incidence of AF and VTE (median follow-up 19.8 years). Incident AF and VTE events were identified via active surveillance and defined by relevant hospital discharge ICD codes. VTE events were validated by medical record review. Multivariable-adjusted Cox proportional hazards regression models were used, with AF modeled as a time-dependent covariate. We also evaluated separately risk of PE without evidence of DVT, DVT without PE, and events presenting with both PE and DVT. Results: At baseline participants were on average 54 years old, 55% female and 26% black. In the absence of AF there were 678 VTE events, for an incidence rate of 2.6 per 1000 person-years. After an AF diagnosis there were 77 events, with an incidence rate of 7.1 per 1000 person-years. In multivariable-adjusted models, having AF (versus no AF) was associated with a greater risk of incident VTE; the HR (95% CI) was 2.10 (1.65-2.68) after adjustment for demographics, 1.82 (1.42-2.32) additionally accounting for numerous AF and VTE risk factors, and 1.97 (1.53-2.53) after further adjusting for time-dependent anticoagulant use. When we restricted to PE events without evidence of DVT there were 188 events in total, of which 19 occurred following a diagnosis of AF. The HR for AF (versus no AF) was 1.53 (0.92-2.56) in fully adjusted models. For DVT alone there were 384 events in total, of which 48 occurred after AF diagnosis; the HR for AF was 2.43 (1.77-3.33). Among the 116 events presenting with both DVT and PE, 10 occurred after AF diagnosis, and the HR for AF was 1.36 (0.67-2.75). Conclusions: Diagnosis with AF was associated with a nearly 2-fold increased risk of incident VTE. The association was not stronger when isolated to those with PE without DVT, suggesting that higher risk of VTE among AF patients may be due to either the coagulation abnormalities that accompany AF, or shared risk factors that were not fully accounted for in this analysis.

Abstract P123: Prospective Association Between Periodontal Disease And Brain Imaging Markers Of Cerebrovascular And Neurodegenerative Disease: The Atherosclerosis Risk In Communities Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Hamdi S Adam ◽  
Kamakshi Lakshminarayan ◽  
Wendy Wang ◽  
Faye L Norby ◽  
Thomas Mosley ◽  
...  
Keyword(s):  
Periodontal Disease ◽  
Brain Aging ◽  
Small Vessel Disease ◽  
Brain Mri ◽  
Standardized Uptake Value ◽  
Tissue Loss ◽  
Total Brain Volume ◽  
Brain Volumes ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk

Background: Periodontal disease (PD) is associated positively with neurocognitive outcomes. Few studies have investigated the relationship between PD and indicators of brain aging and vascular changes. Hypothesis: PD is associated with greater cerebral small vessel disease, lower total and regional brain volumes and elevated β-amyloid (Aβ) deposition. Methods: We included 6,793 participants who received full-mouth periodontal examinations and tooth counts at Visit 4 (1996-1998) of the Atherosclerosis Risk in Communities Study. We used a modified 3-level version of the Periodontal Profile Class to categorize PD based on severity and extent of gingival inflammation and tissue loss. Among participants who attended Visit 5 (2011-2013), n=1,306 received a brain MRI and n=248 received a PET scan. Total brain volume, Alzheimer’s disease signature volume, and presence of microhemorrhages and cerebral infarctions were ascertained via 3T MRI; Aβ deposition was assessed from PET. We regressed brain volumes on baseline PD status using weighted multivariable linear regression. Presence of cerebrovascular microhemorrhages, infarctions, or elevated Aβ (standardized uptake value ratio>1.2) were regressed on PD category using logistic models. We examined the interaction between Apolipoprotein E ε4 ( APOE ) allele possession and PD categories on the Aβ outcome. Results: Prevalence of baseline periodontal disease was 73% (959/1306) and 87% (206/248) among the MRI and PET subgroups, respectively. PD was not associated with volumetric brain measures nor microhemorrhages. PD was inversely associated with the odds of subcortical and lacunar infarctions. PD and Aβ were not associated in main effect or interaction analyses, although there was a notably stronger association among carriers of APOE . Conclusion: PD was not associated with altered brain structure, cerebral microhemorrhages or elevated Aβ deposition. Counter to the hypothesis, PD and complete tooth loss were inversely associated with cerebral infarctions.

Abstract MP34: The Association Between Periodontal Disease And Incident Heart Failure: The Atherosclerosis Risk In Communities Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Rebecca L Molinsky ◽  
Faye L Norby ◽  
Bing Yu ◽  
Amil M Shah ◽  
Pamela L Lutsey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Periodontal Disease ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Atherosclerosis Risk In Communities ◽  
Increased Risk ◽  
Atherosclerosis Risk ◽  
Incident Heart Failure

Introduction: Periodontal disease, resulting from inflammatory host-response to dysbiotic subgingival microbiota, has been associated with incident hypertension, heart attack, stroke and diabetes. Limited data exist investigating the prospective relationship between periodontal disease and incident heart failure (HF) and HF subtypes. We hypothesize that periodontal disease is associated with increased risk for heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). Methods: We studied 6,707 participants enrolled in the Atherosclerosis Risk in Communities Study who received a full-mouth clinical periodontal examination at visit 4 (1996-1998) and had longitudinal follow-up starting in 2005. Participants were classified as being periodontally healthy, having periodontal disease (based on the Periodontal Profile Classification (PPC)), or being edentulous. Hospitalization records were reviewed, and HF events were adjudicated and classified as HFpEF, HFrEF or HF of unknown ejection fraction (HFunknownEF) from 2005-2018. We used multivariable-adjusted Cox proportional hazards models to assess the association between periodontal disease or edentulism and incident HF. Results: Among participants 58% had periodontitis and 19% were edentulous. During a median follow-up time of 13 years, 1,178 cases of incident HF occurred (350 HFpEF, 319 HFrEF and 509 HFunknownEF). Periodontal disease and being edentulous were both associated with increased risk for both HFpEF and HFrEF (Table). Conclusion: Periodontal disease measured in mid-life was associated with both incident HFpEF and HFrEF. Adverse microbial exposures underlying periodontal disease might represent a modifiable risk factor for inflammation-induced heart failure pathophysiology.

scholarly journals Secondhand Smoke and Periodontal Disease: Atherosclerosis Risk in Communities Study

2011 ◽  
Vol 101 (S1) ◽  
pp. S339-S346 ◽  
Author(s):  
Anne E. Sanders ◽  
Gary D. Slade ◽  
James D. Beck ◽  
Helga Ágústsdóttir
Keyword(s):  
Periodontal Disease ◽  
Secondhand Smoke ◽  
Atherosclerosis Risk In Communities ◽  
Atherosclerosis Risk

scholarly journals Relationship Between Periodontal Disease and C-Reactive Protein Among Adults in the Atherosclerosis Risk in Communities Study

2003 ◽  
Vol 163 (10) ◽  
pp. 1172 ◽  
Author(s):  
Gary D. Slade ◽  
Elisa M. Ghezzi ◽  
Gerardo Heiss ◽  
James D. Beck ◽  
Estelle Riche ◽  
...  
Keyword(s):  
Periodontal Disease ◽  
C Reactive Protein ◽  
Atherosclerosis Risk In Communities ◽  
Reactive Protein ◽  
Atherosclerosis Risk

scholarly journals Prospective Study of Endogenous Hormones and Incidence of Venous Thromboembolism: The Atherosclerosis Risk in Communities Study

2018 ◽  
Vol 118 (11) ◽  
pp. 1940-1950 ◽  
Author(s):  
Nicholas Roetker ◽  
Richard MacLehose ◽  
Ron Hoogeveen ◽  
Christie Ballantyne ◽  
Saonli Basu ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Hormone Replacement ◽  
Plasma Concentrations ◽  
Cox Proportional Hazards ◽  
Sex Hormone Binding Globulin ◽  
Endogenous Hormones ◽  
Atherosclerosis Risk In Communities ◽  
Menopausal Women ◽  
Atherosclerosis Risk ◽  
Post Menopausal

AbstractExogenous hormone treatments in women (oral contraceptives and hormone replacement therapy [HRT]) are established risk factors for venous thromboembolism (VTE), but less is known about associations between plasma levels of endogenous hormones and VTE risk. We examined the association of baseline dehydroepiandrosterone sulphate (DHEAS), testosterone and sex hormone-binding globulin (SHBG) with risk of future VTE in men and post-menopausal women in the Atherosclerosis Risk in Communities Study. Testosterone, DHEAS and SHBG were measured in plasma samples collected in 1996 to 1998. Cox proportional hazards models were used to estimate hazard ratios for incident VTE adjusting for age, race/ethnicity, body mass index, height, smoking, estimated glomerular filtration rate and C-reactive protein. All analyses were stratified by sex and by current HRT use in women. Among 3,051 non-HRT-using women, 1,414 HRT-using women and 3,925 men at risk at baseline, 184, 62 and 206 experienced incident VTE after a median follow-up of 17.6 years. Plasma hormones were not associated with incidence of VTE among men and non-HRT-using women, although lower plasma DHEAS, when modelled using quartiles or restricted cubic splines, was associated with higher risk of VTE among HRT-using women. This study does not support the existence of an important association between plasma concentrations of endogenous testosterone, DHEAS or SHBG with risk of VTE in middle-aged to older men or post-menopausal women not using HRT.

Abstract MP75: Glycemia (Hemoglobin A1c) is Not Related to Incident Venous Thromboembolism in the Atherosclerosis Risk in Communities Study

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Elizabeth J Bell ◽  
Pamela L Lutsey ◽  
Vijay Nambi ◽  
Mary Cushman ◽  
Elizabeth Selvin ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Smoking Status ◽  
Cox Proportional Hazards ◽  
Self Report ◽  
Diabetes Diagnosis ◽  
Atherosclerosis Risk In Communities ◽  
Increased Risk ◽  
Atherosclerosis Risk ◽  
Diagnosed Diabetes

Introduction— Diabetes has been inconsistently associated with increased risk of venous thromboembolism (VTE). Glycemia is positively associated with coagulation activation and hypofibrinolysis, resulting in a procoagulant state. However, there is little direct evidence on associations of glycemia with VTE. Hypothesis— Glycemia, as measured by hemoglobin A 1c (A 1c ), is positively associated with incident VTE over a follow-up period of 15 years. Methods— The Atherosclerosis Risk in Communities (ARIC) study is a population-based cohort study of middle-aged adults followed for 15 years after visit 2, when A 1c was measured. Because A 1c is affected by treatment in diagnosed diabetics, separate analyses were conducted for individuals with diagnosed diabetes. Diagnosed diabetes was defined as taking diabetes medication or a history of diabetes (self-report). We assessed the relation between A 1c and incident VTE during follow-up using Cox proportional hazards models, controlling for potential confounders: age, sex, race, smoking status and amount, hormone use, body mass index, and waist-to-hip ratio. Results— The cohort free of VTE and/or anticoagulant use in 1990-1992 included 11,976 participants without a diagnosis of diabetes (317 VTE events) and 1,040 participants with a diagnosis of diabetes (45 VTE events). As shown in the figure, the adjusted hazard ratio estimates, using participants with an A 1c < 5.70 % and without diagnosed diabetes as the referent, were close to 1, regardless of A 1c level and diabetes diagnosis status. Further, there was no relation in analyses conducted by VTE type (provoked and unprovoked) or in participants with diabetes (both diagnosed and undiagnosed) relative to those without diabetes. Conclusions— In conclusion, although a modest association cannot be ruled out, our findings do not support an association between A 1c and VTE.

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