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Using data from the Third National Health and Nutrition Examination Survey (1988-1994), the authors examined the relation between periodontal health and cardiovascular risk factors: serum total and high density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen. A total of 10,146 participants were included in the analyses of cholesterol and C-reactive protein and 4,461 in the analyses of fibrinogen. Periodontal health indicators included the gingival bleeding index, calculus index, and periodontal disease status (defined by pocket depth and attachment loss). While cholesterol and fibrinogen were analyzed as continuous variables, C-reactive protein was dichotomized into two levels. The results show a significant relation between indicators of poor periodontal status and increased C-reactive protein and fibrinogen. The association between periodontal status and total cholesterol level is much weaker. No consistent association between periodontal status and high density lipoprotein cholesterol was detectable. Similar patterns of association were observed for participants aged 17-54 years and those 55 years and older. In conclusion, this study suggests that total cholesterol, C-reactive protein, and fibrinogen are possible intermediate factors that may link periodontal disease to elevated cardiovascular risk.

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OBJECTIVE -To assess coronary heart disease (CHD) risk within levels of the joint distribution of non-HDL and LDL cholesterol among individuals with and without diabetes.RESEARCH DESIGN AND METHODS -We used four publicly available data sets for this pooled post hoc analysis and confined the eligible subjects to white individuals aged Ն30 years and free of CHD at baseline (12,660 men and 6,721 women). Diabetes status was defined as either "reported by physician-diagnosed and on medication" or having a fasting glucose level Ն126 mg/dl at the baseline examination. The primary end point was CHD death. Within diabetes categories, risk was assessed based on lipid levels (in mg/dl): non-HDL Ͻ130 and LDL Ͻ100 (group 1); non-HDL Ͻ130 and LDL Ն100 (group 2); non-HDL Ն130 and LDL Ͻ100 (group 3); and non-HDL Ն130 and LDL Ն100 (group 4). Group 1 within those without diabetes was the overall reference group.RESULTS -Of the subjects studied, ϳ6% of men and 4% of women were defined as having diabetes. A total of 773 CHD deaths occurred during the average 13 years of follow-up time. A Cox proportional hazard model was used to estimate the relative risk (RR) of CHD death. Those with diabetes had a 200% higher RR than those without diabetes. In a multivariate model, CHD risk in those with diabetes did not increase with increasing LDL, whereas it did increase with increasing non-HDL: RR (95% confidence interval) for group 1: 5.7 (2.0 -16.8); group 2: 5.7 (1.6 -20.7); group 3: 7.2 (2.6 -19.8); and group 4: 7.1 (3.7-13.6).CONCLUSIONS -Non-HDL is a stronger predictor of CHD death among those with diabetes than LDL and should be given more consideration in the clinical approach to risk reduction among diabetic patients. Diabetes Care 28:1916 -1921, 2005P atients with diabetes have more than a 200% greater risk of cardiovascular diseases (CVDs) than nondiabetic individuals (1). Growing evidence suggests that dyslipidemia contributes significantly to the excess risk of CVD (2). Retrospective subgroup analysis and prospective studies have shown that lipid-lowering therapy can slow the progression of atherosclerosis and decrease the risk for cardiovascular events in patients with diabetes (3).Common characteristic features of diabetic dyslipidemia are the elevation of plasma triglycerides and triglyceride-rich VLDL cholesterol, reduced HDL cholesterol, and an increased number of small dense LDL cholesterol particles (2). Based on epidemiology studies linking diabetic dyslipidemia to coronary heart disease (CHD), together with preliminary evidence from the major statin trials, the American Diabetes Association (ADA) has updated guidelines that outline the priorities for the treatment of dyslipidemia among patients with diabetes (4). The National Cholesterol Education Program Adult Treatment Panel III (ATP III) defined diabetes as a CHD risk equivalent with an LDL treatment goal of Ͻ100 mg/dl (5). Although patients are divided into risk categories according to their levels of LDL, HDL cholesterol, and triglycerides, both the ADA and the ATP ...

Periodontal disease is an important risk factor for total CVA and, in particular, nonhemorrhagic stroke.