{
  "abstract": "Background Periodontal disease has been implicated as a cerebrovascular risk factor through systemic inflammatory pathways. However, studies using administrative data may be confounded by surveillance bias. We aimed to determine whether associations between periodontal disease and cerebrovascular outcomes persist when neuroimaging confirmation is required.Methods We conducted a retrospective cohort study using the TriNetX federated network (109 healthcare organizations, 2016-2026). Two parallel analyses were performed. In the first analysis, patients with periodontal disease (ICD-10: K05) were compared to controls with dental encounters without periodontal diagnosis, excluding prior cerebrovascular disease. In the second analysis, patients were required to have at least one CT or MRI of the head or neck performed on or after the index date to ensure imaging-confirmed diagnoses. Propensity score matching balanced demographics, comorbidities, and medications. Outcomes included ischemic stroke, unruptured intracranial aneurysm, subarachnoid hemorrhage (SAH), arteriovenous malformation (AVM), transient ischemic attack (TIA), and major adverse cardiovascular events (MACE), defined as acute myocardial infarction, heart failure, chronic ischemic heart disease, or atrial fibrillation.Results In the analysis without imaging confirmation, 530,713 periodontitis and 328,007 control patients were identified. After propensity score matching, 244,896 pairs were analyzed with balanced characteristics (mean age 30.4 vs 28.7 years; female 52.6% vs 52.3%; hypertension 15.3% vs 14.1%; diabetes 7.3% vs 6.7%; mean follow-up 1,107 vs 1,097 days). Periodontal disease was associated with significantly elevated odds of ischemic stroke (OR 1.31, 95% CI 1.23-1.39, p<0.001), SAH (OR 1.35, 95% CI 1.15-1.58, p<0.001), AVM (OR 2.24, 95% CI 1.40-3.59, p=0.001), TIA (OR 1.41, 95% CI 1.28-1.54, p<0.001), and MACE (OR 1.13, 95% CI 1.10-1.17, p<0.001). Aneurysm development showed a non-significant trend (OR 1.13, 95% CI 0.98-1.31, p=0.094). When restricted to patients with at least one CT or MRI of the head or neck, 16,234 matched pairs were analyzed. All cerebrovascular associations were attenuated to non-significance: ischemic stroke (OR 1.00, 95% CI 0.91-1.09, p=0.93), SAH (OR 0.94, 95% CI 0.77-1.13, p=0.49), aneurysm (OR 0.86, 95% CI 0.70-1.07, p=0.19), AVM (OR 1.69, 95% CI 0.85-3.36, p=0.13), and TIA (OR 1.01, 95% CI 0.88-1.16, p=0.90). MACE risk was paradoxically lower in the periodontitis cohort (OR 0.88, 95% CI 0.83-0.94, p<0.001).Conclusion Associations between periodontal disease and cerebrovascular events in administrative data are likely confounded by differential surveillance intensity. When restricted to imaging-confirmed cases, these associations disappear, suggesting ascertainment bias rather than true causality.Disclosures M. Essibayi: None.",
  "authors": [
    {
      "affiliations": [
        "Neurosurgery, Albert Einstein College of Medicine, Bronx, NY"
      ],
      "name": "M Essibayi"
    },
    {
      "affiliations": [
        "Bronx, NY"
      ],
      "name": "D Lakhani"
    },
    {
      "affiliations": [
        "Bronx, NY"
      ],
      "name": "D Altschul"
    }
  ],
  "title": "E-363 Association between periodontal disease and cerebrovascular pathology: a propensity score-matched analysis with and without neuroimaging confirmation",
  "uid": "1b7dcfac-dd24-59c3-b025-9b18605ab37f"
}