Endodontic therapy and incident cardiovascular disease: The Atherosclerosis Risk in Communities (ARIC) study

Logan T. Cowan, Kamakshi Lakshminarayan, Pamela L. Lutsey, James Beck, Steven Offenbacher, James S. Pankow

Research output: Contribution to journalArticle


Objectives: Previous studies on a potential association between endodontic infection (EI) and cardiovascular disease (CVD) produced mixed results. Endodontic treatment (ET) may also be linked to cardiovascular risk, as a marker for prior chronic dental infection and subclinical EI in other teeth. We tested the hypothesis that ET is associated with elevated risk of coronary heart disease (CHD), ischemic stroke (IS), heart failure (HF), or venous thromboembolism (VTE). Methods: ARIC participants who completed the dental ancillary study exam 4 (1996–1998; n = 6,638) were included in the analyses. Participants were followed through 2013 for CHD, stroke, and HF and 2011 for VTE. Cox-proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for CHD, IS, HF, and VTE across ET classifications adjusting for age, sex, race/center, education, income, smoking, alcohol consumption, BMI, statin use, family history of CHD, physical activity, diet quality, insurance status, last dental visit, dental visit frequency, having a current dentist, and tooth loss due to gum disease. Results: Among participants, 21.0% reported a single ET, while 28.5% reported multiple ETs. Over a median of 15.8 years of follow-up, there were 506 incident CHD events, 311 IS events, 739 HF events, and 219 VTE events. There were no significant associations between self-reported history of ET and any of our outcomes (HR (95%CI): CHD = 1.16 (0.87,1.44), IS = 0.77 (0.55,1.09), HF = 1.00 (0.81,1.24), VTE = 0.98 (0.67,1.43)) after adjustment. Conclusions: Our results do not support an independent association between ET and development of CHD, IS, HF, or VTE.

Original languageEnglish (US)
Pages (from-to)79-91
Number of pages13
JournalJournal of Public Health Dentistry
Issue number1
StatePublished - Jan 1 2020


  • cardiovascular diseases
  • coronary disease
  • endodontic
  • endodontic treatment
  • heart failure
  • infection
  • stroke
  • venous thromboembolism

PubMed: MeSH publication types

  • Journal Article

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