Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study.

Der-Yuan Chen,Ching-Heng Lin,Hsin-Hua Chen,Yi-Ming Chen,Alena Talkachova

doi:10.1371/journal.pone.0165601

Abstract

ObjectiveTo investigate the risk of atrial fibrillation or atrial flutter in patients with periodontitis (PD) in comparison with individuals without PD.MethodsWe used the 1999–2010 Taiwanese National Health Insurance Research Database to identify cases of PD in the year 2000 matching (1:1) with persons without PD during 1999–2000 according to sex and individual age as the control group. Using Cox proportional regression analysis adjusting for potential confounders, including age, sex, and comorbidities at baseline, and average annual number of ambulatory visits and dental scaling frequency during the follow-up period, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to examine the risk of atrial fibrillation or flutter in PD patients in comparison with the control group. Subgroup analyses according to age, gender, or comorbidities were conducted to study the robustness of the association and investigate possible interaction effects.ResultsWe enrolled 393,745 patients with PD and 393,745 non-PD individuals. The incidence rates of atrial fibrillation or flutter were 200 per 105 years among the PD group and 181 per 105 years in the non-PD group (incidence rate ratio, 1.10; 95% CI, 1.06–1.14). After adjusting for potential confounders, we found an increased risk of atrial fibrillation or flutter in the PD group compared with the non-PD group (HR, 1.31; 95% CI, 1.25–1.36). The greater risk of atrial fibrillation or flutter in the PD group remained significant across all disease subgroups except hyperthyroidism and sleep apnea.ConclusionThe present study results indicate an increased risk of atrial fibrillation or flutter in patients with PD. Lack of individual information about alcohol consumption, obesity, and tobacco use was a major limitation.

Highlights

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia worldwide
The incidence rates of atrial fibrillation or flutter were 200 per 105 years among the PD group and 181 per 105 years in the non-PD group
After adjusting for potential confounders, we found an increased risk of atrial fibrillation or flutter in the PD group compared with the non-PD group (HR, 1.31; 95% confidence intervals (CIs), 1.25–1.36)

Summary

Introduction

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia worldwide. The prevalence of AF is increasing in Western countries as well as in China [1,2,3]. Systemic inflammation, characterized by serum inflammatory markers including tumor necrosis factor-α, interleukin (IL)-6, IL-2, and C-reactive protein, were associated with a higher risk of AF development [11, 13,14,15]. Previous studies have shown that some chronic inflammatory diseases, such as rheumatoid arthritis and psoriasis, were associated with a higher risk of AF development [16,17,18,19,20]. One study showed that the use of corticosteroid, an anti-inflammatory agent, decreased the risk of AF recurrence after electrical cardioversion [21]. It is reasonable to hypothesize that systemic inflammation may lead to the development of AF [7]

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Results

Conclusion