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January 3, 2001

Periodontal Disease and Risk of Coronary Heart Disease—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2001;285(1):40-41. doi:10.1001/jama.285.1.39

In Reply: Dr Genco and colleagues suggest that our conclusion of lack of a moderate-to-large association between PD and CHD is "premature and unsubstantiated." They are concerned about misclassification bias, long follow-up time with possible dilution effects, and the apparently inconsistent findings of other studies. We respond to each of these criticisms in turn.

Misclassification bias: Genco et al describe our PD measures as "subjective and less accurate" than the objective measures used, for instance, by Beck et al,1 who showed a "strong association." However, in a field beset by lack of a standard definition of periodontitis, there is no evidence that our surrogate markers are less accurate or more subjective in measuring PD than the surrogate markers used in studies with positive findings.2 Furthermore, the odds ratio of 1.5 in the study by Beck et al does not represent a strong association, especially since it was not adjusted for smoking.

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