Caroline Minassian, MSc; Francesco D'Aiuto, PhD; Aroon D. Hingorani, PhD; Liam Smeeth, PhD
Acknowledgment: The authors thank GlaxoSmithKline for supplying the Medicaid data and for their advice on using the database. The company had no role in the study design, analysis, interpretation of the findings, or preparation of this manuscript.
Grant Support: In part by a Wellcome Trust Senior Fellowship grant (Dr. Smeeth) and a senior fellowship from the British Heart Foundation (Dr. Hingorani). Dr. D'Aiuto holds a Clinical Senior Lectureship Award supported by the United Kingdom Clinical Research Collaboration. Drs. Hingorani and D'Aiuto work at University College London Hospital–University College London, who received a proportion of funding from the Department of Health's National Institute for Health Research Biomedical Research Centres funding scheme.
Potential Conflicts of Interest: Dr. Hingorani: Grants received/pending: British Heart Foundation and Medical Research Council Research Award on Biomarkers, with Pfizer as a co-funder. Employment: Editorial board member of the Drug and Therapeutics Bulletin, a BMJ Group publication. Other: Received honoraria for speaking at educational meetings and teaching a course on cardiovascular risk. Some of this money was donated to medical charities. Dr. Smeeth: Grants received/pending: Wellcome Trust Senior clinical fellowship. Other: GlaxoSmithKline provided access to the data but had no role in the study design, analysis, or interpretation of the manuscript. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0574.
Reproducible Research Statement:Study protocol and statistical code: Available from Ms. Minassian (e-mail, email@example.com). Data set: Not available.
Requests for Single Reprints: Liam Smeeth, PhD, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. Minassian and Dr. Smeeth: Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
Dr. D'Aiuto: Periodontology Unit, University College London Eastman Dental Institute, 256 Gray's Inn Road, London WC1X 8LD, United Kingdom.
Dr. Hingorani: Genetic Epidemiology Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, United Kingdom.
Author Contributions: Conception and design: L. Smeeth, F. D'Aiuto.
Analysis and interpretation of the data: C. Minassian, L. Smeeth, A.D. Hingorani, F. D'Aiuto.
Drafting of the article: C. Minassian, L. Smeeth, A.D. Hingorani, F. D'Aiuto.
Critical revision of the article for important intellectual content: C. Minassian, L. Smeeth, A.D. Hingorani, F. D'Aiuto.
Final approval of the article: C. Minassian, L. Smeeth, A.D. Hingorani, F. D'Aiuto.
Statistical expertise: C. Minassian, L. Smeeth.
Obtaining of funding: L. Smeeth.
Administrative, technical, or logistic support: F. D'Aiuto.
Minassian C, D'Aiuto F, Hingorani AD, Smeeth L. Invasive Dental Treatment and Risk for Vascular Events: A Self-Controlled Case Series. Ann Intern Med. 2010;153:499-506. doi: 10.7326/0003-4819-153-8-201010190-00006
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Published: Ann Intern Med. 2010;153(8):499-506.
Treatment of periodontal disease may reduce cardiovascular risk in the longer term, but studies have suggested a link among dental procedures, acute inflammation, and endothelial dysfunction. However, whether such acute inflammatory effects translate into a short-lived increased risk for vascular events is not known.
To investigate whether invasive dental treatment transiently increases the risk for vascular events.
Self-controlled case series.
Data came from the U.S. Medicaid claims database.
All persons exposed to invasive dental treatment with a primary hospital discharge diagnosis of ischemic stroke (n = 650) or myocardial infarction (n = 525) from 2002 to 2006.
The incidence of ischemic stroke and myocardial infarction in periods immediately after invasive dental treatment was compared with the incidence in all other observed time periods. Incidence ratios and 95% CIs were calculated.
The rate of vascular events significantly increased in the first 4 weeks after invasive dental treatment (incidence ratio, 1.50 [95% CI, 1.09 to 2.06]) and gradually returned to the baseline rate within 6 months. The positive association remained after exclusion of persons with diabetes, hypertension, or coronary artery disease or persons with prescriptions for antiplatelet or salicylate drugs before treatment.
Power to examine the effects of invasive dental treatment on stroke and myocardial infarction separately was limited because of the low frequency of invasive dental procedures. Lack of information about use of over-the-counter drugs limited the ability to assess confounding by possible withholding of antiplatelet or salicylate drugs before invasive dental treatment or by the use of nonsteroidal anti-inflammatory drugs after treatment.
Invasive dental treatment may be associated with a transient increase in the risk for vascular events. However, the absolute risks are minimal, and the long-term benefits on vascular health will probably outweigh the short-lived adverse effects.
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Cardiology, Emergency Medicine, Acute Coronary Syndromes, Coronary Heart Disease, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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