Objective: To evaluate the interrelation between se-verity of periodontal disease (PD), coronary calcium, subclinical atherosclerosis and plaque vulnerability in patients with unstable angina (UA), who underwent coronary computed tomography angiography (CCTA). Methods: 52 patients with UA were enrolled in the ATHERODENT clinical trial (NCT03395041). All patients underwent: (1) complex dental examinati-on for assessment of periodontal status, expressed by the total periodontal index (PI) evaluating gingival index, plaque index, tratrum index, furcation index, mobility, loss of attachment (PAD), pocket depth and papillary bleeding index (PBI); (2) CCTA for analysis of morphology, composition and vulnerability featu-res of the culprit coronary plaques. For each patient, coronary calcium score, body mass index, neck and abdominal circumference and intima-media thickness of the carotid artery were calculated. According to the median value of the total PI (set by 22) the study popu-lation was divided into two groups: group 1: 26 patients with low PI and group 2:26 patients with high total PI. Results: Plaque volume (p=0.019) and the non-calci-fied volume (p=0.002) were more increased in patients with high PI. The severity of PI was correlated with the presence of vulnerability features (positive remodeling, low density atheroma, spotty calcification and napkin ring sign) compared with those with low risk plaqu-es (28.20 ± 13.34 vs. 18.71 ± 11.31, p=0.001). Plaque vulnerability was significantly correlated with PAD (3.6 ± 2.91 vs. 1.66 ± 1.8, p=0.009) and PBI (4.5 ± 3.06 vs. 2.04 ± 1.96, p=0.002). Between PD and subclinical atherosclerosis (expressed by the circumference of the neck and abdomen, the intima-mean carotid index), no significant correlation was obtained. However, total PI presented significantly correlation with the calcium score (r=0.45, p=0.0008). A higher calcium score was identified in patients with high PI (505.29 ± 478.64 vs. 93.82 ± 233.0, p=0.0001).

Conclusions: In patients with vulnerable coronary plaques, subclinical atherosclerosis is not correlated with the PI. However, the severity of PD is directly associated with the total calcium score and with a more vulnerable phenotype of the atheromatous coronary plaques.