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 journalArticlepeer-review

7 Scopus citations


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

Bibliographical note

Funding Information:
We thank the staff and participants of the ARIC study for their important contributions. The ARIC study was supported by National Heart, Lung, and Blood Institute (NHLBI) contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C. The LITE study was funded by National Heart, Lung, and Blood Institute (NHLBI) grant R01 HL59367. The collection and analysis of dental data were supported by the National Institute of Dental and Craniofacial Research (grants DE 13807‐01A1 and DE1 1551) L.T.C. was supported by an NHLBI training grant T32 HL007779.

Publisher Copyright:
© 2020 American Association of Public Health Dentistry


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


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