Subclinical cardiovascular disease markers applicable to studies of oral health: Multiethnic study of atherosclerosis

Recent findings associate periodontal disease with established coronary heart disease (CHD) and with disorders of the carotid artery. Besides measures of the carotid artery, a number of other noninvasive subclinical markers of cardiovascular disease exist and are summarized here. Included are computed tomography (CT) of the coronary arteries, ultrasound of the carotid arteries, echocardiography, magnetic resonance imaging (MRI), ankle-brachial index, microalbuminuria, and other biochemical measures of kidney dysfunction, flow-mediated dilation in the brachial artery, and pulse wave form analysis. Use of these measures may simplify and add depth to studies of oral health and cardiovascular disease. However, it is noted that the measures are not highly correlated with each other (based on 6,814 persons in the Multiethnic Study of Atherosclerosis, Pearson correlations among the above subclinical measures, range from about 0.1-0.4), do not include propensity for the important atherosclerotic phase of plaque rupture, and do not fully substitute for studies of clinical cardiovascular disease endpoints.