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Dr. Wehrmacher expresses concern that reliance on participant self-reports of periodontal disease in our analysis of periodontal disease and subsequent cardiovascular disease in the Physicians’ Health Study (1)probably resulted in the failure to include some cases of periodontal disease. We agree that some cases of periodontal disease may have been missed. However, as discussed in the study, the magnitude of any such misclassification (which is likely to have been random with respect to subsequent cardiovascular disease) is unlikely to have caused us to miss a two- to threefold increased risk of cardiovascular disease reported in earlier studies. Furthermore, as also discussed in the study, associations were noted between reported periodontal disease and age and cigarette smoking, two acknowledged risk factors for periodontal disease, providing support for the validity of this measure in our study. Finally, the small (10% to 20%), and statistically nonsignificant, increased risks of nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death were all reduced to the null value of 1.0 after adjustment for cigarette smoking and other cardiovascular risk factors.
- American College of Cardiology