Synergistic effect of periodontitis and C-reactive protein levels on mortality: NHANES 2001-2004
Periodontitis is associated with elevated C-reactive protein (CRP) levels. Although the coexistence of periodontitis and elevated CRP levels may heighten the risk of mortality, previous studies have not confirmed their synergistic effect. Understanding this interaction is crucial for identifying pot...
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| creator | Han, Miyeun Lee, Whanhee Ahn, Seoyeong Kang, Moon Ho Hwang, Hyeon Seok Kwon, Soie Kim, Yaerim Lee, Jeonghwan Kim, Dong Ki Lim, Chun Soo Kim, Yon Su Lee, Jung Pyo |
| description | Periodontitis is associated with elevated C-reactive protein (CRP) levels. Although the coexistence of periodontitis and elevated CRP levels may heighten the risk of mortality, previous studies have not confirmed their synergistic effect. Understanding this interaction is crucial for identifying potential interventions to reduce mortality risk in individuals with periodontitis. This study aimed to assess the synergistic effects of periodontitis and elevated CRP levels on mortality in 7,938 adult individuals who participated in the National Health and Nutrition Examination Study 2001-2004. The association of periodontitis status and CRP levels with mortality was assessed using a survey-weighted Cox model. The interactive effect was estimated; the synergistic effect of CRP levels and periodontitis status on mortality was assessed using the relative excess risk due to interaction (RERI). Periodontitis was diagnosed in 1,065 (13.4%) participants. Compared with the participants without periodontitis and possessing CRP levels of ≤ 0.5 mg/dL, those with periodontitis (hazard ratio [HR], 1.38) or CRP levels of > 0.5 mg/dL (HR 1.23) had higher HRs. The participants with both periodontitis and CRP levels of > 0.5 mg/dL had the highest HR of 2.01. The additive scale interactive effect of the periodontal status and CRP levels, measured using RERI 0.41 (-0.07, 0.95), was positive and nearly significant in the total population. The synergy between the periodontal status and CRP levels was more prominent in the participants aged ≥60 years than that in younger individuals. Periodontitis with high CRP levels may indicate a high mortality rate, indicating the importance of active monitoring and intensive management of periodontitis and inflammatory markers. |
| doi_str_mv | 10.1371/journal.pone.0309476 |
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Although the coexistence of periodontitis and elevated CRP levels may heighten the risk of mortality, previous studies have not confirmed their synergistic effect. Understanding this interaction is crucial for identifying potential interventions to reduce mortality risk in individuals with periodontitis. This study aimed to assess the synergistic effects of periodontitis and elevated CRP levels on mortality in 7,938 adult individuals who participated in the National Health and Nutrition Examination Study 2001-2004. The association of periodontitis status and CRP levels with mortality was assessed using a survey-weighted Cox model. The interactive effect was estimated; the synergistic effect of CRP levels and periodontitis status on mortality was assessed using the relative excess risk due to interaction (RERI). Periodontitis was diagnosed in 1,065 (13.4%) participants. Compared with the participants without periodontitis and possessing CRP levels of ≤ 0.5 mg/dL, those with periodontitis (hazard ratio [HR], 1.38) or CRP levels of > 0.5 mg/dL (HR 1.23) had higher HRs. The participants with both periodontitis and CRP levels of > 0.5 mg/dL had the highest HR of 2.01. The additive scale interactive effect of the periodontal status and CRP levels, measured using RERI 0.41 (-0.07, 0.95), was positive and nearly significant in the total population. The synergy between the periodontal status and CRP levels was more prominent in the participants aged ≥60 years than that in younger individuals. Periodontitis with high CRP levels may indicate a high mortality rate, indicating the importance of active monitoring and intensive management of periodontitis and inflammatory markers.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0309476</identifier><identifier>PMID: 39453923</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Age ; Aged ; Atherosclerosis ; Body mass index ; C-reactive protein ; C-Reactive Protein - analysis ; C-Reactive Protein - metabolism ; Cardiovascular disease ; Chronic illnesses ; Coexistence ; Creatinine ; Ethnicity ; Female ; Gum disease ; Health aspects ; Health risks ; Humans ; Hypertension ; Inflammation ; Kidney diseases ; Male ; Measurement ; Medical laboratories ; Middle Aged ; Mortality ; Mortality risk ; Nutrition Surveys ; Oral hygiene ; Patient outcomes ; Periodontitis ; Periodontitis - blood ; Periodontitis - mortality ; Population ; Proportional Hazards Models ; Proteins ; Risk Factors ; Risk reduction ; Statistical analysis ; Statistics ; Synergistic effect ; United States - epidemiology ; Urine ; Variables</subject><ispartof>PloS one, 2024-10, Vol.19 (10), p.e0309476</ispartof><rights>Copyright: © 2024 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</rights><rights>COPYRIGHT 2024 Public Library of Science</rights><rights>2024 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 Han et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c470t-806e45b98d5d22c95e67c946322477c958737d3e9356d59c90720bfc40fa83e33</cites><orcidid>0000-0002-4064-7322 ; 0000-0002-0878-5469 ; 0000-0003-1596-1528 ; 0000-0002-4714-1260 ; 0000-0001-9123-6542</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0309476&type=printable$$EPDF$$P50$$Gplos$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0309476$$EHTML$$P50$$Gplos$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,860,2096,2915,23845,27901,27902,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39453923$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Han, Miyeun</creatorcontrib><creatorcontrib>Lee, Whanhee</creatorcontrib><creatorcontrib>Ahn, Seoyeong</creatorcontrib><creatorcontrib>Kang, Moon Ho</creatorcontrib><creatorcontrib>Hwang, Hyeon Seok</creatorcontrib><creatorcontrib>Kwon, Soie</creatorcontrib><creatorcontrib>Kim, Yaerim</creatorcontrib><creatorcontrib>Lee, Jeonghwan</creatorcontrib><creatorcontrib>Kim, Dong Ki</creatorcontrib><creatorcontrib>Lim, Chun Soo</creatorcontrib><creatorcontrib>Kim, Yon Su</creatorcontrib><creatorcontrib>Lee, Jung Pyo</creatorcontrib><title>Synergistic effect of periodontitis and C-reactive protein levels on mortality: NHANES 2001-2004</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Periodontitis is associated with elevated C-reactive protein (CRP) levels. Although the coexistence of periodontitis and elevated CRP levels may heighten the risk of mortality, previous studies have not confirmed their synergistic effect. Understanding this interaction is crucial for identifying potential interventions to reduce mortality risk in individuals with periodontitis. This study aimed to assess the synergistic effects of periodontitis and elevated CRP levels on mortality in 7,938 adult individuals who participated in the National Health and Nutrition Examination Study 2001-2004. The association of periodontitis status and CRP levels with mortality was assessed using a survey-weighted Cox model. The interactive effect was estimated; the synergistic effect of CRP levels and periodontitis status on mortality was assessed using the relative excess risk due to interaction (RERI). Periodontitis was diagnosed in 1,065 (13.4%) participants. Compared with the participants without periodontitis and possessing CRP levels of ≤ 0.5 mg/dL, those with periodontitis (hazard ratio [HR], 1.38) or CRP levels of > 0.5 mg/dL (HR 1.23) had higher HRs. The participants with both periodontitis and CRP levels of > 0.5 mg/dL had the highest HR of 2.01. The additive scale interactive effect of the periodontal status and CRP levels, measured using RERI 0.41 (-0.07, 0.95), was positive and nearly significant in the total population. The synergy between the periodontal status and CRP levels was more prominent in the participants aged ≥60 years than that in younger individuals. Periodontitis with high CRP levels may indicate a high mortality rate, indicating the importance of active monitoring and intensive management of periodontitis and inflammatory markers.</description><subject>Adult</subject><subject>Age</subject><subject>Aged</subject><subject>Atherosclerosis</subject><subject>Body mass index</subject><subject>C-reactive protein</subject><subject>C-Reactive Protein - analysis</subject><subject>C-Reactive Protein - metabolism</subject><subject>Cardiovascular disease</subject><subject>Chronic illnesses</subject><subject>Coexistence</subject><subject>Creatinine</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Gum disease</subject><subject>Health aspects</subject><subject>Health risks</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Inflammation</subject><subject>Kidney diseases</subject><subject>Male</subject><subject>Measurement</subject><subject>Medical laboratories</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Mortality risk</subject><subject>Nutrition Surveys</subject><subject>Oral hygiene</subject><subject>Patient outcomes</subject><subject>Periodontitis</subject><subject>Periodontitis - blood</subject><subject>Periodontitis - mortality</subject><subject>Population</subject><subject>Proportional Hazards Models</subject><subject>Proteins</subject><subject>Risk Factors</subject><subject>Risk reduction</subject><subject>Statistical analysis</subject><subject>Statistics</subject><subject>Synergistic effect</subject><subject>United States - epidemiology</subject><subject>Urine</subject><subject>Variables</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNklFrFDEUhQdRbK3-A9GAIPowaybJzCS-LUu1C6UFV32NmczNNsvsZJtkSvffN-tOS1f6IIHkcvnOveFwsuxtgScFrYsvKzf4XnWTjethgikWrK6eZceFoCSvCKbPH9VH2asQVhiXlFfVy-yIClZSQehx9mex7cEvbYhWIzAGdETOoA1461rXRxttQKpv0Sz3oHS0N4A23kWwPergBrqAXI_WzkfV2bj9ii7OphenC0QwLvJ0sdfZC6O6AG_G9yT79e305-wsP7_8Pp9Nz3PNahxzjitgZSN4W7aEaFFCVWvBKkoIq1NV8prWLQVBy6othRa4JrgxmmGjOAVKT7L3-7mbzgU5mhMkLQjmScOKRMz3ROvUSm68XSu_lU5Z-bfh_FIqn2zoQAKh3NQcswJTxhltcNkAY4qZWvOGmjTr07jNu-sBQpRrGzR0nerBDfu1osCC44R--Ad9-nMjtVRpv-2Ni17p3VA55QWtSEXIbtbkCSqdFtZWpyAYm_oHgs8HgsREuI1LNYQg54sf_89e_j5kPz5ir0B18Sq4bojW9eEQZHtQexeCB_NgfIHlLsf3bshdjuWY4yR7N5o2NGtoH0T3waV3xtvnzw</recordid><startdate>20241025</startdate><enddate>20241025</enddate><creator>Han, Miyeun</creator><creator>Lee, Whanhee</creator><creator>Ahn, Seoyeong</creator><creator>Kang, Moon Ho</creator><creator>Hwang, Hyeon Seok</creator><creator>Kwon, Soie</creator><creator>Kim, Yaerim</creator><creator>Lee, Jeonghwan</creator><creator>Kim, Dong Ki</creator><creator>Lim, Chun Soo</creator><creator>Kim, Yon Su</creator><creator>Lee, Jung Pyo</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-4064-7322</orcidid><orcidid>https://orcid.org/0000-0002-0878-5469</orcidid><orcidid>https://orcid.org/0000-0003-1596-1528</orcidid><orcidid>https://orcid.org/0000-0002-4714-1260</orcidid><orcidid>https://orcid.org/0000-0001-9123-6542</orcidid></search><sort><creationdate>20241025</creationdate><title>Synergistic effect of periodontitis and C-reactive protein levels on mortality: NHANES 2001-2004</title><author>Han, Miyeun ; Lee, Whanhee ; Ahn, Seoyeong ; Kang, Moon Ho ; Hwang, Hyeon Seok ; Kwon, Soie ; Kim, Yaerim ; Lee, Jeonghwan ; Kim, Dong Ki ; Lim, Chun Soo ; Kim, Yon Su ; Lee, Jung Pyo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c470t-806e45b98d5d22c95e67c946322477c958737d3e9356d59c90720bfc40fa83e33</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Age</topic><topic>Aged</topic><topic>Atherosclerosis</topic><topic>Body mass index</topic><topic>C-reactive protein</topic><topic>C-Reactive Protein - 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Although the coexistence of periodontitis and elevated CRP levels may heighten the risk of mortality, previous studies have not confirmed their synergistic effect. Understanding this interaction is crucial for identifying potential interventions to reduce mortality risk in individuals with periodontitis. This study aimed to assess the synergistic effects of periodontitis and elevated CRP levels on mortality in 7,938 adult individuals who participated in the National Health and Nutrition Examination Study 2001-2004. The association of periodontitis status and CRP levels with mortality was assessed using a survey-weighted Cox model. The interactive effect was estimated; the synergistic effect of CRP levels and periodontitis status on mortality was assessed using the relative excess risk due to interaction (RERI). Periodontitis was diagnosed in 1,065 (13.4%) participants. Compared with the participants without periodontitis and possessing CRP levels of ≤ 0.5 mg/dL, those with periodontitis (hazard ratio [HR], 1.38) or CRP levels of > 0.5 mg/dL (HR 1.23) had higher HRs. The participants with both periodontitis and CRP levels of > 0.5 mg/dL had the highest HR of 2.01. The additive scale interactive effect of the periodontal status and CRP levels, measured using RERI 0.41 (-0.07, 0.95), was positive and nearly significant in the total population. The synergy between the periodontal status and CRP levels was more prominent in the participants aged ≥60 years than that in younger individuals. Periodontitis with high CRP levels may indicate a high mortality rate, indicating the importance of active monitoring and intensive management of periodontitis and inflammatory markers.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>39453923</pmid><doi>10.1371/journal.pone.0309476</doi><tpages>e0309476</tpages><orcidid>https://orcid.org/0000-0002-4064-7322</orcidid><orcidid>https://orcid.org/0000-0002-0878-5469</orcidid><orcidid>https://orcid.org/0000-0003-1596-1528</orcidid><orcidid>https://orcid.org/0000-0002-4714-1260</orcidid><orcidid>https://orcid.org/0000-0001-9123-6542</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_3120835641 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Adult Age Aged Atherosclerosis Body mass index C-reactive protein C-Reactive Protein - analysis C-Reactive Protein - metabolism Cardiovascular disease Chronic illnesses Coexistence Creatinine Ethnicity Female Gum disease Health aspects Health risks Humans Hypertension Inflammation Kidney diseases Male Measurement Medical laboratories Middle Aged Mortality Mortality risk Nutrition Surveys Oral hygiene Patient outcomes Periodontitis Periodontitis - blood Periodontitis - mortality Population Proportional Hazards Models Proteins Risk Factors Risk reduction Statistical analysis Statistics Synergistic effect United States - epidemiology Urine Variables |
| title | Synergistic effect of periodontitis and C-reactive protein levels on mortality: NHANES 2001-2004 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T20%3A33%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Synergistic%20effect%20of%20periodontitis%20and%20C-reactive%20protein%20levels%20on%20mortality:%20NHANES%202001-2004&rft.jtitle=PloS%20one&rft.au=Han,%20Miyeun&rft.date=2024-10-25&rft.volume=19&rft.issue=10&rft.spage=e0309476&rft.pages=e0309476-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0309476&rft_dat=%3Cgale_plos_%3EA813626220%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3120835641&rft_id=info:pmid/39453923&rft_galeid=A813626220&rft_doaj_id=oai_doaj_org_article_e238f78041034843b05be44a4f7c8b3f&rfr_iscdi=true |