Skip to main content
Top
Published in: Clinical Oral Investigations 3/2019

Open Access 01-03-2019 | Original Article

Carotid calcifications in panoramic radiographs are associated with future stroke or ischemic heart diseases: a long-term follow-up study

Authors: Viveca Wallin Bengtsson, G. Rutger Persson, Johan Berglund, Stefan Renvert

Published in: Clinical Oral Investigations | Issue 3/2019

Login to get access

Abstract

Objective

To assess if carotid calcifications detected in panoramic radiographs are associated with future events of stroke, and/or ischemic heart diseases over 10–13 years in individuals between 60 and 96 years.

Materials and methods

Baseline (2001–2004) panoramic radiographs were assessed for evidence of carotid calcifications from individuals with no previous history of stroke and/or ischemic heart diseases. A radiopaque nodular mass adjacent to the cervical vertebrae, at or below the intervertebral space C3–C4, was interpreted as carotid calcification. Annual medical records were searched for ICD 10 codes through 2014.

Results

Signs of carotid calcification was demonstrated in 238/635 (37.5%) of the study individuals. Signs of carotid calcification was associated with future stroke and/or ischemic heart diseases (χ2 = 9.1, OR 1.6, 95% CI 1.2, 2.2, p < 0.002). In individuals 60–72 years, a significant association between radiographic signs of carotid calcification and stroke and/or ischemic heart diseases (χ2 = 12.4, OR 2.4, 95% CI 1.5, 4.0, p < 0.000) (adjusted for high blood pressure, diabetes type 2, BMI; OR 1.9, 95% CI 1.1, 3.5, p = 0.03). Individuals (60–72 years) with radiographic evidence of carotid calcifications had a mean cumulative stroke and/or ischemic heart diseases survival time of 12.1 years compared to those without such evidence (13.0 years) (log rank Mantel-Cox χ2 = 10.7, p = 0.001).

Conclusions

Evidence of carotid calcifications in panoramic radiographs is associated with an event of stroke and/or ischemic heart diseases in 60–96-year-old individuals.

Clinical relevance

Radiographic evidence of carotid calcifications is associated with stroke and/or ischemic heart diseases. Patients with signs of carotid calcifications should therefore be referred for medical examination.
Literature
1.
go back to reference Cheng C, Tempel D, van Haperen R, van der Baan A, Grosveld F, Daemen MJ, Krams R, de Crom R (2006) Atherosclerotic lesion size and vulnerability are determined by patters of fluid shear stress. Circulation 113:2744–2753CrossRefPubMed Cheng C, Tempel D, van Haperen R, van der Baan A, Grosveld F, Daemen MJ, Krams R, de Crom R (2006) Atherosclerotic lesion size and vulnerability are determined by patters of fluid shear stress. Circulation 113:2744–2753CrossRefPubMed
2.
go back to reference Minino AM, Murphy SL, Xu J, Kochanek KD (2011) Deaths: final data for 2008. Natl Vital Stat Rep 59:1–126PubMed Minino AM, Murphy SL, Xu J, Kochanek KD (2011) Deaths: final data for 2008. Natl Vital Stat Rep 59:1–126PubMed
3.
go back to reference van Gils MJ, Vukadinovic D, van Dijk AC, Dippel DW, Niessen WJ, van der Lugt A (2012) Carotid atherosclerotic plaque progression and change in plaque composition over time: a 5-year follow-up study using serial CT angiography. AJNR Am J Neuroradiol 33(7):1267–1273CrossRefPubMed van Gils MJ, Vukadinovic D, van Dijk AC, Dippel DW, Niessen WJ, van der Lugt A (2012) Carotid atherosclerotic plaque progression and change in plaque composition over time: a 5-year follow-up study using serial CT angiography. AJNR Am J Neuroradiol 33(7):1267–1273CrossRefPubMed
4.
go back to reference Esposito-Bauer L, Saam T, Ghodrati I, Pelisek J, Heider P, Bauer M, Wolf P, Bockelbrink A, Feurer R, Sepp D, Winkler C, Zepper P, Boeckh-Behrens T, Riemenschneider M, Hemmer B, Poppert H (2013) MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients. PLoS One 24(8):7, 67927 Esposito-Bauer L, Saam T, Ghodrati I, Pelisek J, Heider P, Bauer M, Wolf P, Bockelbrink A, Feurer R, Sepp D, Winkler C, Zepper P, Boeckh-Behrens T, Riemenschneider M, Hemmer B, Poppert H (2013) MRI plaque imaging detects carotid plaques with a high risk for future cerebrovascular events in asymptomatic patients. PLoS One 24(8):7, 67927
5.
go back to reference Hollander M, Hak AE, Koudstaal PJ, Bots ML, Grobbee DE, Hofman A, Witteman JC, Breteler MM (2003) Comparison between measures of atherosclerosis and risk of stroke: the Rotterdam study. Stroke 34:2367–2373CrossRef Hollander M, Hak AE, Koudstaal PJ, Bots ML, Grobbee DE, Hofman A, Witteman JC, Breteler MM (2003) Comparison between measures of atherosclerosis and risk of stroke: the Rotterdam study. Stroke 34:2367–2373CrossRef
6.
go back to reference Johansson E, Ahlqvist J, Garoff M, Levring Jäghagen E, Meimermondt A, Wester P (2015) Carotid calcifications on panoramic radiographs: a 5-year follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol 120(4):513–520CrossRefPubMed Johansson E, Ahlqvist J, Garoff M, Levring Jäghagen E, Meimermondt A, Wester P (2015) Carotid calcifications on panoramic radiographs: a 5-year follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol 120(4):513–520CrossRefPubMed
7.
go back to reference Bos D, Leening MJ, Kavousi M, Hofman A, Franco OH, van der Lugt A, Vernooij MW, Ikram MA (2015) Comparison of atherosclerotic calcification in major vessel beds on the risk of all-cause and cause-specific mortality: the Rotterdam study. Circ Cardiovasc Imaging 8(12):e003843CrossRefPubMed Bos D, Leening MJ, Kavousi M, Hofman A, Franco OH, van der Lugt A, Vernooij MW, Ikram MA (2015) Comparison of atherosclerotic calcification in major vessel beds on the risk of all-cause and cause-specific mortality: the Rotterdam study. Circ Cardiovasc Imaging 8(12):e003843CrossRefPubMed
8.
go back to reference Denzel C, Lell M, Maak M, Höckl M, Balzer K, Müller KM, Fellner C, Fellner FA, Lang W (2004) Carotid artery calcium: accuracy of a calcium score by computed tomography-an in vitro study with comparison to sonography and histology. Eur J Vasc Endovasc Surg 28(2):214–220CrossRefPubMed Denzel C, Lell M, Maak M, Höckl M, Balzer K, Müller KM, Fellner C, Fellner FA, Lang W (2004) Carotid artery calcium: accuracy of a calcium score by computed tomography-an in vitro study with comparison to sonography and histology. Eur J Vasc Endovasc Surg 28(2):214–220CrossRefPubMed
9.
go back to reference Huibers A, de Borst GJ, Wan S, Kennedy F, Giannopoulos A, Moll FL, Richards T (2015) Non-invasive carotid artery imaging to identify the vulnerable plaque: current status and future goals. Eur J Vasc Endovasc Surg 50(5):563–572CrossRefPubMed Huibers A, de Borst GJ, Wan S, Kennedy F, Giannopoulos A, Moll FL, Richards T (2015) Non-invasive carotid artery imaging to identify the vulnerable plaque: current status and future goals. Eur J Vasc Endovasc Surg 50(5):563–572CrossRefPubMed
10.
go back to reference Langlois Y, Roederer GO, Chan A, Phillips DJ, Beach KW, Martin D, Chikos PM, Strandness DE Jr.(1983) Evaluating carotid artery disease. The concordance between pulsed Doppler/spectrum analysis and angiography. Ultrasound Med Biol 9(1):51–63CrossRefPubMed Langlois Y, Roederer GO, Chan A, Phillips DJ, Beach KW, Martin D, Chikos PM, Strandness DE Jr.(1983) Evaluating carotid artery disease. The concordance between pulsed Doppler/spectrum analysis and angiography. Ultrasound Med Biol 9(1):51–63CrossRefPubMed
11.
go back to reference Friedlander AH, Baker JD (1994) Panoramic radiography; an aid in detecting patients at risk of cerebrovascular accident. Am Dent Assoc 125:1598–1603CrossRef Friedlander AH, Baker JD (1994) Panoramic radiography; an aid in detecting patients at risk of cerebrovascular accident. Am Dent Assoc 125:1598–1603CrossRef
12.
go back to reference Friedlander AH, El Saden SM, Hazboun RC, Chang TI, Wong WK, Garrett NR (2015) Detection of carotid artery calcification on the panoramic images of post-menopausal females is significantly associated with severe abdominal aortic calcification: a risk indicator of future adverse vascular events. Dentomaxillofac Radiol 44(7):20150094CrossRefPubMedPubMedCentral Friedlander AH, El Saden SM, Hazboun RC, Chang TI, Wong WK, Garrett NR (2015) Detection of carotid artery calcification on the panoramic images of post-menopausal females is significantly associated with severe abdominal aortic calcification: a risk indicator of future adverse vascular events. Dentomaxillofac Radiol 44(7):20150094CrossRefPubMedPubMedCentral
13.
go back to reference Cohen S, Friedlander A, Jolly D, Date L (2002) Carotid calcification on panoramic radiographs: an important marker for vascular risk. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:510–514CrossRefPubMed Cohen S, Friedlander A, Jolly D, Date L (2002) Carotid calcification on panoramic radiographs: an important marker for vascular risk. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 94:510–514CrossRefPubMed
14.
go back to reference Persson RE, Hollender LG, Powell VL, MacEntee M, Wyatt CC, Kiyak HA, Persson GR (2002) Assessment of periodontal conditions and systemic disease in older subjects II focus on cardiovascular diseases. J Clin Periodontol 29:803–810CrossRefPubMed Persson RE, Hollender LG, Powell VL, MacEntee M, Wyatt CC, Kiyak HA, Persson GR (2002) Assessment of periodontal conditions and systemic disease in older subjects II focus on cardiovascular diseases. J Clin Periodontol 29:803–810CrossRefPubMed
15.
go back to reference Kumagai M, Yamagishi T, Fukui N, Chiba M (2007) Carotid artery calcifications seen on panoramic dental radiographs in the Asian population in Japan. Dentomaxillofacial Radiology 36:92–96CrossRefPubMed Kumagai M, Yamagishi T, Fukui N, Chiba M (2007) Carotid artery calcifications seen on panoramic dental radiographs in the Asian population in Japan. Dentomaxillofacial Radiology 36:92–96CrossRefPubMed
16.
go back to reference Tanaka T, Morimoto Y, Ansai T, Okabe S, Yamada K, Taguchi A, Awano S, Kito S, Takata Y, Takehara T, Ohba T (2006) Can the presence of carotid artery calcification on panoramic radiographs predict the risk of vascular diseases among 80-year olds? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101(6):777–783CrossRefPubMed Tanaka T, Morimoto Y, Ansai T, Okabe S, Yamada K, Taguchi A, Awano S, Kito S, Takata Y, Takehara T, Ohba T (2006) Can the presence of carotid artery calcification on panoramic radiographs predict the risk of vascular diseases among 80-year olds? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101(6):777–783CrossRefPubMed
17.
go back to reference Lee JS, Kim OS, Chung HJ, Kim YJ, Kweon SS, Lee YH, Shin MH, Yoon SJ (2014) The correlation of carotid artery calcification on panoramic radiographs and determination of carotid artery atherosclerosis with ultrasonography. Oral Surg Oral Med Oral Pathol Oral Radiol 118(6):739–745CrossRefPubMed Lee JS, Kim OS, Chung HJ, Kim YJ, Kweon SS, Lee YH, Shin MH, Yoon SJ (2014) The correlation of carotid artery calcification on panoramic radiographs and determination of carotid artery atherosclerosis with ultrasonography. Oral Surg Oral Med Oral Pathol Oral Radiol 118(6):739–745CrossRefPubMed
18.
go back to reference Ravon NA, Hollender LG, McDonald V, Persson GR (2003) Signs of carotid calcification from dental panoramic radiographs are in agreement with Doppler sonography results. J Clin Periodontol 30(12):1084–1090CrossRefPubMed Ravon NA, Hollender LG, McDonald V, Persson GR (2003) Signs of carotid calcification from dental panoramic radiographs are in agreement with Doppler sonography results. J Clin Periodontol 30(12):1084–1090CrossRefPubMed
19.
go back to reference Johansson EP, Ahlqvist J, Garoff M, Karp K, Jäghagen EL, Wester P (2011, 2011) Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study. BMC Cardiovasc Disord 11:44 Johansson EP, Ahlqvist J, Garoff M, Karp K, Jäghagen EL, Wester P (2011, 2011) Ultrasound screening for asymptomatic carotid stenosis in subjects with calcifications in the area of the carotid arteries on panoramic radiographs: a cross-sectional study. BMC Cardiovasc Disord 11:44
20.
go back to reference Carter LC, Haller AD, Nadarajah V, Calamel AD, Aguirre A (1997, 1997) Use of panoramic radiography among an ambulatory dental population to detect patients at risk of stroke. J Am Dent Assoc 128(7):977–984 Carter LC, Haller AD, Nadarajah V, Calamel AD, Aguirre A (1997, 1997) Use of panoramic radiography among an ambulatory dental population to detect patients at risk of stroke. J Am Dent Assoc 128(7):977–984
21.
go back to reference Ohba T, Takata Y, Ansai T, Morimoto Y, Tanaka T, Kito S, Awano S, Akifusa S, Takehara T (2003) Evaluation of calcified carotid artery atheromas detected by panoramic radiograph among 80-year-olds. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96(5):647–650CrossRefPubMed Ohba T, Takata Y, Ansai T, Morimoto Y, Tanaka T, Kito S, Awano S, Akifusa S, Takehara T (2003) Evaluation of calcified carotid artery atheromas detected by panoramic radiograph among 80-year-olds. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 96(5):647–650CrossRefPubMed
22.
go back to reference Bengtsson VW, Persson GR, Renvert S (2014) Assessment of carotid calcifications on panoramic radiographs in relation to other used methods and relationship to periodontitis and stroke: a literature review. Acta OdontScand 72(6):401–412 Bengtsson VW, Persson GR, Renvert S (2014) Assessment of carotid calcifications on panoramic radiographs in relation to other used methods and relationship to periodontitis and stroke: a literature review. Acta OdontScand 72(6):401–412
23.
go back to reference Friedlander AH, Cohen SN (2007) Panoramic radiographic atheromas portend adverse vascular events. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(6):830–835CrossRefPubMed Friedlander AH, Cohen SN (2007) Panoramic radiographic atheromas portend adverse vascular events. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(6):830–835CrossRefPubMed
24.
go back to reference Persson RE, Hollender LG, Powell VL, MacEntee M, Wyatt CC, Kiyak HA, Persson GR (2002) Assessment of periodontal conditions and systemic disease in older subjects. II. Focus on cardiovascular diseases. J Clin Periodontol 29(9):803–810CrossRefPubMed Persson RE, Hollender LG, Powell VL, MacEntee M, Wyatt CC, Kiyak HA, Persson GR (2002) Assessment of periodontal conditions and systemic disease in older subjects. II. Focus on cardiovascular diseases. J Clin Periodontol 29(9):803–810CrossRefPubMed
25.
go back to reference Lewis DA, Brooks SL (1999) Cartoid artery calcification in a general dental population: a retrospective study of panoramic radiographs. Gen Dent 47(1):98–103PubMed Lewis DA, Brooks SL (1999) Cartoid artery calcification in a general dental population: a retrospective study of panoramic radiographs. Gen Dent 47(1):98–103PubMed
26.
go back to reference Christou P, Leemann B, Scimmel M, Kiliaridis S, Müller F (2010) Carotid artery calcification in ischemic stroke patients detected in a standard dental panoramic radiographs a preliminary study. Adv Med Sci 55:26–31CrossRefPubMed Christou P, Leemann B, Scimmel M, Kiliaridis S, Müller F (2010) Carotid artery calcification in ischemic stroke patients detected in a standard dental panoramic radiographs a preliminary study. Adv Med Sci 55:26–31CrossRefPubMed
27.
go back to reference Almog DM, Tsimidis K, Moss ME, Gottilieb RH, Carter LC (2000) Evaluation of a training program for detection of carotid artery calcifications on panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:111–117CrossRefPubMed Almog DM, Tsimidis K, Moss ME, Gottilieb RH, Carter LC (2000) Evaluation of a training program for detection of carotid artery calcifications on panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:111–117CrossRefPubMed
28.
go back to reference Carter LC (2000) Discrimination between calcified triticeous cartilage and calcified carotid atheroma on panoramic radiography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:108–110CrossRefPubMed Carter LC (2000) Discrimination between calcified triticeous cartilage and calcified carotid atheroma on panoramic radiography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90:108–110CrossRefPubMed
29.
go back to reference Kamikawa RS, Fenyo-Pereira M, Fernandes A, Meurer MT (2006) Study of the localization of radiopacities similar to calcified carotid atheroma by means of panoramic radiography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:374–378CrossRefPubMed Kamikawa RS, Fenyo-Pereira M, Fernandes A, Meurer MT (2006) Study of the localization of radiopacities similar to calcified carotid atheroma by means of panoramic radiography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:374–378CrossRefPubMed
Metadata
Title
Carotid calcifications in panoramic radiographs are associated with future stroke or ischemic heart diseases: a long-term follow-up study
Authors
Viveca Wallin Bengtsson
G. Rutger Persson
Johan Berglund
Stefan Renvert
Publication date
01-03-2019
Publisher
Springer Berlin Heidelberg
Published in
Clinical Oral Investigations / Issue 3/2019
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI
https://doi.org/10.1007/s00784-018-2533-8

Other articles of this Issue 3/2019

Clinical Oral Investigations 3/2019 Go to the issue