Periodontitis is a potential risk factor for transient ischemic attack and minor ischemic stroke in young adults: A nationwide population‐based cohort study

Abstract

Background: This study aims to determine whether periodontitis is a risk factor for transient ischemic attack (TIA) in young adults. Methods:The National Health Insurance (NHI) Research Database in Taiwan was the source of the data used in this retrospective cohort study. Individuals aged 20 to 53 years with periodontitis in 2001 and 2002 (n = 792,426) and an ageand sex-matched control group (n = 792,426) were selected. All participants were followed up until TIA diagnosis, 55 years of age, removal from the NHI program, death, or December 31, 2016. The incidence density and hazard ratio (HR) of newonset TIA were compared between individuals with periodontitis and controls.Periodontitis was defined by dentists according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 523.3-5 with concurrent antibiotic prescription or periodontal treatment excluding scaling performed by certified dentists. TIA was defined according to the ICD-9-CM code 435.x at hospital discharge. Results: After adjustment for confounding factors, the risk of developing TIA/minor ischemic stroke was calculated to be higher in participants with periodontitis (HR, 1.24; 95% confidence interval, 1.15-1.32; P <0.001) than in those without. The HR was slightly higher among people aged 20 to 40 years than among those aged 40 to 53 years. Conclusion: Periodontitis is associated with an increased risk of developing TIA/minor ischemic stroke. Periodontitis might be a modifiable risk factor for stroke in young adults. Clinicians must devote greater attention to this potential association to develop new preventive and therapeutic strategies for stroke in young adults.

Periodontitis, Dental Procedures, and Young-Onset Cryptogenic Stroke

“…Stroke severity has not been previously reported to associate with periodontal parameters in young-onset CIS, as in the current study, but the association has been suggested in older participants (Slowik et al 2010). More recent studies have also demonstrated associations between stroke and periodontitis (Lin et al 2019;Lee et al 2022), but evidence using the current classification of periodontitis applied in our study has been limited. We note that recent studies showing an association between periodontitis and ischemic stroke did not include education or socioeconomic level among the confounding factors (Lin et al 2019;Lee et al 2022).…”

“…More recent studies have also demonstrated associations between stroke and periodontitis (Lin et al 2019;Lee et al 2022), but evidence using the current classification of periodontitis applied in our study has been limited. We note that recent studies showing an association between periodontitis and ischemic stroke did not include education or socioeconomic level among the confounding factors (Lin et al 2019;Lee et al 2022). Our study used education as a measure of socioeconomic status, since along with occupational classes, it is a good predictor of health in Finnish epidemiological studies (Laaksonen et al 2005).…”

“…Prior studies have suggested periodontitis as an independent risk factor for ischemic stroke (Grau et al 2004). Recently, a large Taiwanese retrospective cohort study showed that a registered periodontitis diagnosis is associated with an increased risk of developing a transient ischemic attack or a minor ischemic stroke in young adults, suggesting a stronger association for the age group of 20- to 40-y-olds than for 41- to 53-y-olds (Lee et al 2022). Furthermore, compared to older ones, younger patients with ischemic stroke exhibit a larger proportion of strokes with unknown etiology, that is, they are labeled as CIS even after thorough and timely clinical examination (Martinez-Majander et al 2021).…”

Risk of Peripheral Arterial Occlusive Disease with Periodontitis and Dental Scaling: A Nationwide Population-Based Cohort Study

“…In a nationwide population-based cohort study, male patients with chronic PD had a higher risk of carotid atherosclerosis [ 17 ]. Furthermore, PD was also associated with transient ischemic attack and minor ischemic stroke in juveniles [ 27 ]. Therefore, a close relationship between PD and PAOD is expected.…”

Does Periodontitis Affect the Association of Biological Aging with Mortality?

“…In contrast, healthy lifestyles can reduce the mortality risk in the elderly population by promoting healthy aging (Jin et al 2022). Periodontitis is suggested as a modifiable risk factor for age-related diseases (Lee et al 2017(Lee et al , 2022. Of note, patients with moderate/severe periodontitis were associated with 47% increased odds of shorter leukocyte telomere length, a molecular marker of aging, when compared with controls (Song et al 2021).…”