Title of project

From Gums to Heart: Untangling the Link Between Periodontitis and Cardiovascular Disease in Type 2 Diabetes

Abstract

During my PhD studies, I have demonstrated that periodontitis, a chronic inflammatory disease affecting the gums and supporting bone, often coexists with microvascular complications of diabetes. My research, published in the highest impact factor journal in Dentistry, revealed that the presence of severe periodontitis was associated with 50% higher prevalence of diabetic neuropathy and retinopathy. In addition, I have shown the significant role of lipid dysregulation in periodontitis, proposing that dyslipidemia exacerbates diabetes-induced vascular changes, potentially aggravated by chronic gum inflammation. However, these previous findings were derived from cross-sectional data, and it remains unclear whether periodontitis and type 2 diabetes act synergistically elevating the risk of early-onset peripheral artery disease and mortality. To address this knowledge gap, my subsequent research will provide a robust longitudinal data and advanced analytical approach to strengthen causal inference, utilizing datasets from Denmark and Finland. Building on this foundation, the next step in my research is to unravel the role of periodontitis in peripheral artery disease, which poses unique challenges for individuals with type 2 diabetes. Therefore, I aim to conduct three studies using two large Nordic register-based data in partnership with Steno Diabetes Center Aarhus, Aarhus University and the University of Eastern Finland, as follows: Study 1 – to evaluate whether long-term periodontitis increases the risk of early-onset of peripheral artery disease among participants with type 2 diabetes; Study 2 – to assess the extent to which dental treatment influences HbA1c and lipid levels, peripheral artery disease, and cardiovascular mortality among participants with type 2 diabetes; Study 3 – to estimate the effect of inequalities in healthcare utilization on dental health and cardiovascular-related healthcare costs among participants with type 2 diabetes. Danish data will be obtained from the Health in Central Denmark cohort, an ongoing diabetes research resource with information on over 50,000 individuals, both with and without diabetes, matched by age, sex, and municipality. I will also spend six months at the University of Eastern Finland to expand data collection, focusing on regions such as North Karelia, which has notably high rates of cardiovascular disease and has conducted comprehensive dental health examinations. Both register-based studies are complemented by comprehensive health measurements, blood sampling, and questionnaires. Perspectives: The project includes an international research component, facilitating a comparative analysis with studies conducted in Denmark and Finland. Substantial advancements can be made towards enhancing public health outcomes in Nordic countries.