Association between periodontitis and mortality of patients with cardiovascular diseases: A cohort study based on NHANES

Abstract Background The association between periodontitis and cardiovascular disease (CVD) has been widely explored, but little is known about the effect of periodontitis on the mortality of CVD patients. This study aims to clarify the effect of periodontitis on all‐cause and cause‐specific mortality of CVD patients. Methods We included 2,135 individuals with CVD from the National Health and Nutrition Examination Survey. Mortality data were ascertained by linkage to National Death Index records through 31 December 2019. We used Cox proportional hazards models for all‐cause mortality and competing risk models for CVD and cancer mortality to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Further covariate adjustments, stratification analyses, and a variety of sensitivity analyses were conducted to test the reliability and robustness of the results. Results The all‐cause mortality in CVD patients with moderate/severe periodontitis was significantly higher than in those with no/mild periodontitis (HR: 1.25; 95% CI: 1.02–1.52; P = 0.03). The all‐cause mortality in participants with severe clinical attachment loss was significantly higher (HR: 1.07; 95% CI: 1.01–1.14; P = 0.01). However, no discrepancy in CVD or cancer mortality was observed between CVD patients with different periodontal status. Conclusions Our findings from a longitudinal study with a large sample indicated significant but slightly higher all‐cause mortality in CVD patients with moderate/severe periodontitis than in those with no/mild periodontitis.