Intensive dental treatment after stroke, TIA does not impact vascular events
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Intensive periodontal treatment for gum disease after stroke or transient ischemic attack did not affect the rate of vascular events at 1 year compared with standard treatment, a speaker reported.
However, researchers observed improved rates of vascular events (death, MI or stroke) among study participants with more dental visits, according to findings of the PREMIER trial presented at the International Stroke Conference.
“In the past, studies have shown that gum disease is associated with stroke risk factors, hypertension, hyperglycemia and dyslipidemia. Studies have also shown that gum disease is also associated with mediators of stroke, such as systemic inflammation, atherosclerosis ... and recently we published data on the association of gum disease with atrial fibrillation,” Souvik Sen, MD, MPH, FAHA, professor and chair of the neurology department at the University of South Carolina School of Medicine Columbia, said during the presentation. “Gum disease or periodontal disease is associated with increased risk of stroke, MI and death. It is a prevalent condition worldwide, at 90% worldwide and as much as 50% in the United States. It is prevalent among the disparity population in the ‘Stroke Belt.’”
For the PREMIERS study, researchers analyzed whether intensive periodontal treatment as secondary prevention for patients with recent stroke or TIA, compared with standard periodontal treatment, reduced risk for the primary outcome of stroke, MI and death at 1 year.
Secondary outcomes of interest included BP, glycemic control, dyslipidemia, inflammation and carotid intima-media thickness.
Among patients with recent stroke or TIA who researchers screened for gum disease, periodontal disease was found in 40% of the population.
Researchers randomly assigned 138 participants (mean age, 59 years; 91% men; 73% Black) to receive intensive periodontal treatment, which included supragingival and subgingival removal of plaque and calculus, extraction of hopeless teeth and locally delivered antibiotics. The intensive group also received an electric toothbrush, mouthwash and air flosser for dental care. A total of 142 patients (mean age, 60 years; 89% men; 73% Black) were assigned to standard treatment, which included supragingival removal of plaque and calculus, a regular toothbrush and dental care advice.
According to the presentation, the between-group difference for the primary outcome was no different, with stroke, MI or death occurring in 7.7% of the intensive periodontal treatment group compared with 12.3% of the standard treatment group (HR = 0.65; 95% CI, 0.3-1.38; P = .26; RR = 0.78; 95% CI, 0.48-1.26). However, Sen and colleagues observed a correlation between a greater number of dental visits and reduced probability of vascular events at 1 year (log-rank P = .0017).
For the secondary outcomes at 1 year, diastolic BP improved in both groups (intensive, P = .04; standard, P = .02) and HDL improved in the standard group (P = .03) and trended toward improvement in the intensive group (P = .1), but there were no significant changes in other outcomes.
“In a health disparate population, living in the Stroke Belt, the prevalence of moderately severe gum disease is 40%,” Sen said during the presentation. “The composite event rate was extremely low in both the intensive and the control treatment arm, and there was no significant difference. Compared to a historical arm, there might have been some difference. Importantly, the number of dental visits significantly correlated with lower rates of vascular events. Among the secondary outcomes, all of the secondary measures were headed in the hypothesized direction; specifically, diastolic blood pressure and HDL cholesterol showed some significant changes.”
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Sen S, et al. LB3. Presented at: International Stroke Conference; Feb. 9-11, 2022; New Orleans (hybrid meeting).
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