Oral Infections and Vascular Disease Epidemiology Study (INVEST)

DESCRIPTION (provided by applicant): Several studies suggest that certain infections, including periodontal infections, predispose to atherosclerotic disease. INVEST has contributed significantly to this field. In INVEST period one, we have found that periodontal disease is cross-sectionally associated with carotid artery intima media thickness (IMT). We have further reported that bacteria presumptively causally related to clinical periodontal disease are related positively to IMT, while those associated with periodontal health are not. In INVEST period 2, we demonstrated that progression of atherosclerosis parallels the longitudinal course of the periodontal infections, after adjustment for cardiovascular risk factors, thus establishing a plausible time sequence of periodontal infection and vascular disease, an essential component in attributing causality. Having confirmed our hypothesis that periodontal disease correlates with atherosclerosis both cross-sectionally and prospectively, we now aim to answer the next two critical questions related to causal inference: Does the relationship of periodontal disease with atherosclerosis translate into clinical CVD events? And is periodontal intervention capable of impacting atherosclerotic progression in a subset of our cohort? We propose a novel design within our ongoing cohort to answer both questions. Thus, our first aim is to continue followup of our cohort of 1,014 alive subjects to provide the first evidence of direct association between periodontal microbiology and incident clinical vascular events, beyond subclinical atherosclerosis. Our second aim is to concurrently assess among a random sample of cohort participants(