Associations between periodontal disease and cardiovascular surrogate measures among Indigenous Australians ☆ Kostas Kapellas a, c, ⁎, Lisa M. Jamieson a , Loc G. Do a , P. Mark Bartold b , Hao Wang c , Louise J. Maple-Brown c, d , David Sullivan e, f , Kerin O'Dea g , Alex Brown h , David S. Celermajer i , Gary D. Slade j , Michael R. Skilton k a Australian Research Centre for Population Oral Health, School of Dentistry, University of Adelaide, Adelaide, Australia b Colgate Australian Clinical Dental Research Centre, School of Dentistry, University of Adelaide, Adelaide, Australia c Menzies School of Health Research, Charles Darwin University, Darwin, Australia d Division of Medicine, Royal Darwin Hospital, Darwin, Australia e Royal Prince Alfred Hospital, Camperdown, NSW, Australia f Sydney Medical School, University of Sydney, Sydney, Australia g Sansom Institute for Health Research, University of South Australia, Adelaide, Australia h Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia i Department of Medicine, University of Sydney, Sydney, Australia j Department of Dental Ecology, University of North Carolina at Chapel Hill, USA k Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Sydney, Australia abstract article info Article history: Received 28 October 2013 Received in revised form 20 January 2014 Accepted 13 February 2014 Available online 22 February 2014 Keywords: Arterial stiffening Aboriginal Periodontal disease Type 2 diabetes Smoking Background/objectives: Inflammation is a key pathogenetic factor in atherogenesis. Periodontitis is a chronic inflammatory source which can have systemic impacts. Indigenous Australians have a higher prevalence of peri- odontal disease and experience cardiovascular disease earlier than non-Indigenous Australians. The aim was to describe the association between severity of periodontal inflammatory disease and measures of arterial structure and function. Methods: Periodontal disease in a convenience sample of Indigenous Australians was assessed clinically; for those with periodontal disease, the extent of periodontal pockets ≥4 mm was stratified into quartiles. Vascular health was measured non-invasively via carotid-dorsalis pedis pulse-wave velocity (PWV), and via B-mode ultrasound of the common carotid intima-media (IMT). Non-fasting blood samples were collected for lipid and inflammato- ry marker evaluation. Linear regression models were constructed to determine the associations between extent of periodontal pocketing and vascular health, adjusting for traditional cardiovascular common risk factors. Results: 273 Indigenous Australian adults were recruited and complete data was available for 269 participants (154 males), median age 39 years. Arterial stiffness (PWV) significantly increased with increasing extent of periodontal pocketing (p trend = 0.001). By contrast, carotid IMT did not differ across quartiles. Conclusions: Periodontal pocketing was associated with central arterial stiffness, a marker of presymptomatic arterial dysfunction, in Indigenous Australian adults with periodontal disease. © 2014 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Periodontitis is characterised by chronic low-grade inflammation of the periodontal tissues which results in the destruction of the alveolar bone and formation of pathological pockets around diseased teeth that can lead to tooth loss [1]. Inflammation is a core component of the arterial wall disturbances leading to atherosclerosis [2]. The source of inflammation, however, does not necessarily have to arise from within the artery [3]. Long- term systemic inflammatory events such as those observed in periodon- titis may contribute to atherosclerosis. The various mechanisms in which this may occur have recently been reviewed [4]. Periodontitis and cardiovascular disease (CVD) share common risk factors. For example, both occur more frequently among those with a history of cigarette smoking, people with diabetes and both are also associated with ageing. It is currently unclear whether periodontitis contributes to the initiation and/or progression of atherosclerosis, and if so, to what extent. It remains possible that no causal relationship International Journal of Cardiology 173 (2014) 190–196 ☆ Sources of funding: The PerioCardio study is funded by the National Health and Medical Research Council: project grant #627100. AB is supported by a Viertel Senior Medical Research fellowship. KK was supported with a University of Adelaide Divisional Scholarship during this study; HW was supported by NHMRC Program Grant 1037304; LMB is supported by NHMRC fellowship #605837. MRS is supported by NHMRC fellowship #1004474. LMJ is supported by NHMRC Career Development Award #565260. ⁎ Corresponding author at: Australian Research Centre for Population Oral Health, School of Dentistry, Level 3, 122 Frome Street, University of Adelaide, Adelaide, South Australia 5005, Australia. Tel.: +61 8 8313 7339; fax: +61 8 8313 3070. E-mail address: kostas.kapellas@adelaide.edu.au (K. Kapellas). http://dx.doi.org/10.1016/j.ijcard.2014.02.015 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard