The April JADA systematic literature review by Drs. Muralidhar Mupparapu and Irene Kim, "Calcified Carotid Artery Atheroma and Stroke: A Systematic Review," (
JADA 2007;138[4]:483–92
) concluded that the data are incomplete and inconclusive relative to the hypothesis that panoramic radiographically detectable calcified carotid artery atheromas (CCAA) are associated with an increased risk of stroke. We, in fact, recently have demonstrated that these lesions are associated with the development of adverse, nonfatal cardiovascular events. An electronic version of an in-press publication in a peer-reviewed journal, detailing the results of this new study, has been posted on the National Library of Medicine and National Institutes of Health PubMed Web site since Jan. 29, 2007.1 The study’s design and results respond to many of the objections raised by Drs. Mupparapu and Kim in their review of the literature relative to the clinical significance of CCAA.
We followed 46 individuals (mean age, 66 years) with a CCAA on their panoramic radiographs and a like number of risk-matched controls (mean age, 68 years) lacking a radiograph until they developed as an endpoint an adverse cardiovascular event. The mean time for 12 of the 46 study patients (or 26 percent) to develop an adverse cardiovascular event (six myocardial infarcts, six revascularization procedures [need for stent placement or bypass graft], three strokes, three hospitalizations for angina and two transient ischemic attacks) was 2.9 years.
Five members (or 11 percent) of the control group suffered six adverse cardiovascular events (two hospitalizations for angina, one myocardial infarct, one stroke, one transient ischemic attack, one revascularization procedure) 3.9 years after their cohorts’ radiographs were taken.
The total number of events in the study group (20) was significantly higher than the number in the control group (six), using z test comparing two counts, 2 = 2.746, P = .006.
We conclude that the results of our most recent study demonstrate that individuals with CCAA on their panoramic dental radiographs are at significantly greater risk of suffering an adverse, nonfatal cardiovascular event than are similarly aged individuals with like vascular risk-factor burden. The carotid artery lesions are true independent markers of elevated vascular risk and they, in fact, heralded coronary artery disease (six myocardial infarcts, six revascularization procedures and three hospitalizations for treatment of angina) more often than they did cerebrovascular disease (three cardiovascular accidents and two transient is-chemic attacks).
These associations are not unexpected, given the fact that extracranial carotid artery and coronary artery atherosclerosis are major manifestations of generalized atherosclerosis and that, in the same individual, the disease in the coronary arteries may be more advanced than it is in the carotid artery.2–4
In summary, the incidental finding of calcifications on a panoramic dental radiograph is a powerful marker for future adverse, nonfatal, vascular events and is of significant public health importance given that each year in the United States one million individuals suffer a nonfatal myocardial infarct and one-half million sustain a nonfatal stroke.5
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