May 16, 2002 Dental x-rays may provide a new tool to screen for potentially life-threatening heart conditions and stroke, according to research presented by Stanley N. Cohen, M.D., Director of the Stroke Program in the Division of Neurology at Cedars-Sinai Medical Center. The findings, presented at the 54th annual meeting of the American Academy of Neurology, show that panoramic dental x-rays can be used to spot carotid artery calcification (CAC) – a condition which may contribute to stroke.
“Our study shows that patients with calcification of the carotid arteries had a higher risk for both serious cardiac events and strokes,” said Dr. Cohen. “Now, we recommend that when dentists see CAC on an x-ray, they refer their patients to the appropriate specialists for further evaluation and treatment.”
In the past, the presence of CAC – or calcium deposits that line the walls of the arteries supplying blood to the brain – indicated that patients might need evaluation to determine whether there was blockage, which could lead to a stroke. If blockage was identified, the patients received treatment. On the other hand, if no blockage was found in the carotid arteries, no further testing was done. But earlier studies conducted by one of the researchers found that CAC was not associated with blockage of the carotid arteries, while additional studies by the group found that patients with CAC had a high rate of cardiac and stroke symptoms.
“What remained unclear, was whether CAC was a separate risk factor for heart problems and stroke or whether it was simply a characteristic of patients with numerous risk factors for either condition,” commented Dr. Cohen.
To determine whether the presence of CAC was directly linked to a higher risk for heart attack and stroke, the investigators examined the dental x-rays of male veterans seen by Arthur H. Friedlander, D.M.D., over a 15 year period at the Veterans Affairs Greater Los Angeles Healthcare System. Forty-six patients with CAC were identified and compared to a second, “control” group of 46 patients without CAC who had only age, gender, risk factors for heart disease and stroke, and the first letter of their last names in common.
Next, the investigators examined the medical records of both patient groups for any heart problems and/or strokes that may have occurred after their dental x-rays were taken. Pre-existing risk factors such as any prior heart attack or bypass surgery, stroke, diabetes or obesity were also reviewed for both groups. They found that 34 patients in Group 1 (with CAC) had greater than one risk factor, while seven had no risk factors at all. In Group 2 (without CAC), the investigators found that 29 patients had more than one risk factor, while eight had no risk factors present.
“This means that both groups of patients were very similar in all aspects accept for the presence of calcification in the carotid arteries,” said Dr. Cohen.
In addition, the investigators’ analysis of the patients’ medical records revealed that 20 heart related conditions occurred in 12 patients with CAC present on a dental x-ray, while only six heart or stroke related conditions occurred among five of the patients without CAC. In the group of patients with CAC, the investigators found that six patients had heart attacks, three had strokes, six had obstruction of the blood vessels, two had transient ischemic attacks (TIA), or a a temporary blockage of blood supply to the brain, and three had angina (pain and constriction around the heart). Patients without CAC experienced considerably less cardiac or stroke events with one heart attack, one stroke, one blood vessel blockage, one TIA and two cases of angina. Further, patients with CAC experienced some type of cardiac event or stroke 2.9 years after their x-ray was taken, while patients without CAC experienced an occurrence 3.9 years later – a difference of one year.
“Although CAC does not indicate that the arteries are blocked, it does indicate a patient at higher risk to develop potentially life threatening vascular complications. Therefore, finding CAC on a dental x-ray can help us to identify and begin early intervention in these high risk patients,” said Dr. Cohen.
Cedars-Sinai Medical Center is one of the largest non-profit academic medical centers in the Western United States. For the fifth straight two-year period, Cedars-Sinai has been named Southern California's gold standard in health care in an independent survey. Cedars-Sinai is internationally renowned for its diagnostic and treatment capabilities and its broad spectrum of programs and services, as well as breakthroughs in biomedical research and superlative medical education. Named one of the 100 "Most Wired" hospitals in health care in 2001, the Medical Center ranks among the top 10 non-university hospitals in the nation for its research activities.
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