Changes in Clinical and Microbiological Periodontal Profiles Relate to Progression of Carotid Intima‐Media Thickness: The Oral Infections and Vascular Disease Epidemiology Study

BACKGROUND: No prospective studies exist on the relationship between change in periodontal clinical and microbiological status and progression of carotid atherosclerosis. METHODS AND RESULTS: The Oral Infections and Vascular Disease Epidemiology Study examined 420 participants at baseline (68 ± 8 years old) and follow-up. Over a 3-year median follow-up time, clinical probing depth (PD) measurements were made at 75 766 periodontal sites, and 5008 subgingival samples were collected from dentate participants (average of 7 samples/subject per visit over 2 visits) and quantitatively assessed for 11 known periodontal bacterial species by DNA-DNA checkerboard hybridization. Common carotid artery intima-medial thickness (CCA-IMT) was measured using high-resolution ultrasound. In 2 separate analyses, change in periodontal status (follow-up to baseline), defined as (1) longitudinal change in the extent of sites with a ≥ 3-mm probing depth (Δ%PD ≥ 3) and (2) longitudinal change in the relative predominance of bacteria causative of periodontal disease over other bacteria in the subgingival plaque (Δetiologic dominance), was regressed on longitudinal CCA-IMT progression adjusting for age, sex, race/ethnicity, diabetes, smoking status, education, body mass index, systolic blood pressure, and low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. Mean (SE) CCA-IMT increased during follow-up by 0.139 ± 0.008 mm. Longitudinal IMT progression attenuated with improvement in clinical or microbial periodontal status. Mean CCA-IMT progression varied inversely across quartiles of longitudinal improvement in clinical periodontal status (Δ%PD ≥ 3) by 0.18 (0.02), 0.16 (0.01), 0.14 (0.01), and 0.07 (0.01) mm (P for trend<0.0001). Likewise, mean CCA-IMT increased by 0.20 (0.02), 0.18 (0.02), 0.15 (0.02), and 0.12 (0.02) mm (P<0.0001) across quartiles of longitudinal improvement in periodontal microbial status (Δetiologic dominance). CONCLUSION: Longitudinal improvement in clinical and microbial periodontal status is related to a decreased rate of carotid artery IMT progression at 3-year average follow-up.