Can carotid artery calcifications on dental radiographs predict adverse vascular events? A systematic review
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REVIEW
Can carotid artery calcifications on dental radiographs predict adverse vascular events? A systematic review Li Zhen Lim 1
&
Pamela Shu Fen Koh 1 & Shuo Cao 1 & Raymond Chung Wen Wong 1
Received: 15 September 2020 / Accepted: 10 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To investigate the predictive value of carotid artery calcifications (CACs) seen on dental imaging for future adverse events related to cerebrovascular and cardiovascular diseases. Methods Electronic databases (PubMed, Embase, SCOPUS and Cochrane) and selected grey literature were searched. Outcomes included stroke, transient ischaemic attack (TIA), myocardial infarction (MI), angina, heart failure, future interventional revascularization procedures and death. Risk of bias was assessed using the Newcastle-Ottawa Scale. Results 5 studies were selected from 1011 records. All were of moderate to low risk of bias. Results were heterogeneous but showed that patients with CACs on panoramic radiographs (PANs) were more likely to experience strokes, TIA, MI and future revascularization procedures compared to control groups. The differences between groups were not all found to be statistically significant. Bilateral vessel-outlining CACs were an independent risk marker for future vascular events. Patients who are not currently being managed for cardiovascular risk factors should be referred for further evaluation. Those already being treated for atherosclerosis may not benefit from additional investigations. Conclusion The evidence for the predictive value of CACs on PANs for adverse future vascular events is equivocal but can help to identify at-risk patients who require further evaluation. Clinical relevance Dentists must be able to recognize CACs on PANs and make appropriate referrals for patients to be evaluated for cardiovascular risk factors, especially those who have not previously been assessed. Keywords Carotid artery calcifications . Atheroma . Dental imaging . Panoramic radiographs . Stroke . Myocardial infarction
Introduction Cardiovascular diseases such as ischaemic heart diseases and stroke are the leading causes of death and disability globally. In 2015, there were an estimated 7.29 million acute myocardial infarctions and 110.55 million prevalent cases of ischaemic heart disease [1]. Additionally, the Lancet reported 2.7 million deaths due to ischaemic stroke in 2016 [2]. Early detection of at-risk individuals can help to mitigate the impact of these diseases. Predisposing factors such as age and gender, and modifiable risk factors such as hypertension (HTN), elevated glucose, tobacco
* Li Zhen Lim [email protected] 1
Faculty of Dentistry, National University Centre for Oral Health, Singapore, National University of Singapore, 9 Lower Kent Ridge Road, Singapore 119085, Singapore
usage, high low-density lipoprotein (LDL) levels and low high-density lipoprotein (HDL) levels and obesity have long been established [3]. Using calcifications in the region of the carotid bifurcat
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