Cardiovascular events and mortality among patients and controls with calcified carotid artery atheromas on panoramic radiographs: a 10-year follow-up of the PAROKRANK study

Objectives: This study investigated the long-term risk of cardiovascular events and all-cause mortality among participants with calcified carotid artery atheroma (CCAA) on panoramic radiographs (PRs) in the Periodontitis and its Relation to Coronary Artery Disease (PAROKRANK) study.

Methods: In the multicenter, multidisciplinary PAROKRANK study, 805 patients with a first myocardial infarction (MI) and 805 matched controls without MI were recruited at 17 hospitals in Sweden. At baseline, the participants were examined with PR, and in 737 patients and 739 controls, the carotid artery region was assessable. Calcified carotid artery atheromas were identified in 251 (34%) patients and 205 (28%) controls at baseline. The primary endpoint was defined as the first occurrence of all-cause mortality, non-fatal MI, non-fatal stroke, or hospitalization following heart failure after a mean follow-up of 10 years. The risks of cardiovascular events and death were evaluated using event survival analysis and regression models.

Results: Participants with bilateral CCAAs, regardless of whether they were patients or controls, had significantly higher mortality and morbidity than those without CCAA (P < .001). The risk of cardiovascular events was increased in the presence of bilateral CCAAs among both controls (hazard ratio = 1.96 [95% CI, 1.21-3.16], P = .006) and patients (1.67 [1.15-2.43], P = .007).

Conclusion: Bilateral CCAAs on PRs were an indicator of an increased risk of future cardiovascular events and early death among both controls and patients in the PAROKRANK study. Therefore, dentists can detect CCAA on PR and contribute to identifying individuals in need of medical attention and treatment of cardiovascular disease to prevent morbidity and early death.