Carotid calcifications in panoramic radiographs are associated with future stroke or ischemic heart diseases : a long-term follow-up study

OBJECTIVE: To assess if carotid calcifications detected in panoramic radiographs are associated with future events of stroke, and/or ischemic heart diseases over 10-13 years in individuals between 60 and 96 years. MATERIALS AND METHODS: Baseline (2001-2004) panoramic radiographs were assessed for evidence of carotid calcifications from individuals with no previous history of stroke and/or ischemic heart diseases. A radiopaque nodular mass adjacent to the cervical vertebrae, at or below the intervertebral space C3-C4, was interpreted as carotid calcification. Annual medical records were searched for ICD 10 codes through 2014. RESULTS: Signs of carotid calcification was demonstrated in 238/635 (37.5%) of the study individuals. Signs of carotid calcification was associated with future stroke and/or ischemic heart diseases (χ2 = 9.1, OR 1.6, 95% CI 1.2, 2.2, p < 0.002). In individuals 60-72 years, a significant association between radiographic signs of carotid calcification and stroke and/or ischemic heart diseases (χ2 = 12.4, OR 2.4, 95% CI 1.5, 4.0, p < 0.000) (adjusted for high blood pressure, diabetes type 2, BMI; OR 1.9, 95% CI 1.1, 3.5, p = 0.03). Individuals (60-72 years) with radiographic evidence of carotid calcifications had a mean cumulative stroke and/or ischemic heart diseases survival time of 12.1 years compared to those without such evidence (13.0 years) (log rank Mantel-Cox χ2 = 10.7, p = 0.001). CONCLUSIONS: Evidence of carotid calcifications in panoramic radiographs is associated with an event of stroke and/or ischemic heart diseases in 60-96-year-old individuals. CLINICAL RELEVANCE: Radiographic evidence of carotid calcifications is associated with stroke and/or ischemic heart diseases. Patients with signs of carotid calcifications should therefore be referred for medical examination

Associação entre doença periodontal e aterosclerose subclínica: uma revisão sistemática Association betwenn periodontal disease and subclinic atherosclerosis: a sistematic review

A associação entre doença periodontal e o desenvolvimento de aterosclerose tem sido pesquisada. Esta revisão sistemática da literatura se propõe a verificar a associação entre a doença periodontal e a aterosclerose subclínica. A pesquisa utilizou as bases de dados: PubMed, Scopus, LILACS, BBO, Biblioteca Cochrane e Scielo com os termos: "doença periodontal", "periodontite", "carótida" e "aterosclerose". Foram excluídos artigos: que apresentaram resumos escritos em idiomas diferentes do português, inglês e espanhol; com abordagem laboratorial em modelos experimentais; sem descrição ou referência a estimadores de associação entre doença periodontal e aterosclerose subclínica; pesquisas que realizaram a medida da doença periodontal por parâmetros diferentes de exames clínicos; pesquisas que não analisaram a espessura da íntima média da artéria carótida através de exame de ultrassom; e que abordassem grupos específicos. Foram comparados os desenhos de estudo, protocolos de medida e os dados relatados. De um total de 63 referências, apenas 10 artigos contemplavam todos os critérios de inclusão, distribuídos em: 1 estudo longitudinal, 6 transversais e 3 casos controles. Observou-se uma heterogeneidade entre os estudos em relação ao método de mensuração da doença periodontal e os desfechos da aterosclerose. Concluiu-se que infecções periodontais são fortemente associadas ao desenvolvimento da aterosclerose subclínica, entretanto os mecanismos envolvidos no processo patogênico ainda permanecem desconhecidos.<br>The association between periodontal disease and the development of atherosclerosis has been studied. The systematic review of literature aims to evaluate the association between periodontal disease and subclinical atherosclerosis. A literature search of the PubMed, Scopus, LILACS, BBO, Cochrane Library and Scielo bibliographic databases was conducted using the following descriptors: "periodontal disease", "periodontitis", "carotid", and "therosclerosis". Articles were excluded if they: presented abstracts written in languages other than Portuguese, English and Spanish; experimental studies; did not contain data testing the degree of association between periodontal disease and subclinical atherosclerosis; did measure the extent of periodontal disease by parameters other than the clinical examination; did not measure the carotid artery intima-media wall thickness by ultrasonography; and covered specific population groups. The studies design, measurement protocols and reported data were compared. A total of 63 papers identified only 10 studies that met the inclusion criteria: 1 longitudinal study, 6 cross-sectional, and 3 case control studies. There was a wide heterogeneity between the studies regarding the methods of measuring periodontal disease and atherosclerosis outcomes. The conclusion is that periodontal infections are strongly associated with the development of subclinical atherosclerosis, however the mechanisms involved on the pathogenic process remain unknown