Increased cardiovascular risk in people with type 2 diabetes and periodontitis: an analysis from a global real-world federated database

Introduction Type 2 diabetes (T2D) is a global health challenge conferring significant morbidity and mortality with accelerated cardiovascular, renovascular and cerebrovascular disease. Periodontitis has a higher prevalence in people with diabetes. We aimed to evaluate the risk of incident cardiovascular-related diseases in people with type 2 diabetes with and without periodontitis.Methods We conducted a retrospective cohort study using TriNetX, a global federated health research network of patients ≥18 years with a diagnosis of T2D after the initiation of insulin. Cohorts were divided based on the absence or presence of periodontitis identified using ICD-10 (International Classification of Diseases) codes. Outcomes were recorded at three years from initiation of insulin. The primary outcomes of interest were: 1) mortality; 2) myocardial infarction; 3) stroke; 4) dementia; 5) atrial fibrillation; 6) atrial flutter; 7) diabetic nephropathy; 8) diabetic retinopathy; and 9) infective endocarditis.Results After propensity score matching (1:1), a total of 56,525 patients were identified in each cohort. At three years, patients with periodontitis had similar mortality risk as the control group (risk ratio [RR] plus 95% confidence interval [CI]) (RR: 1.014, 0.979-1.049; p = 0.44). However, the periodontitis cohort demonstrated higher risk of stroke (RR: 1.264, 1.189-1.344; p <0.0001), myocardial infarction (RR: 1.151, 1.084-1.222; p <0.0001), atrial fibrillation (RR: 1.141, 1.08-1.205; p <0.0001), atrial flutter (RR: 1.21, 1.1-1.331; p <0.0001), diabetic retinopathy (RR: 1.735, 1.648-1.826; p <0.0001), diabetic nephropathy (RR: 1.433, 1.35-1.521; p <0.0001), infective endocarditis (RR: 1.83, 1.627-2.059; p <0.0001) and dementia (RR: 1.364, 1.254-1.483; p <0.0001).Conclusion Our findings add to the growing body of evidence that periodontitis is associated with long-term cardiovascular consequences in people with T2D. However, due to the study's retrospective nature, there is a need for well-designed, prospective research, including mechanistic and interventional studies to further explore this relationship.