Tooth loss, poor dental hygiene linked to CHD, mortality
Patients with CHD and self-reported tooth loss had almost double the risk for mortality as patients with CHD and no tooth loss, according to new study results published in the European Journal of Preventive Cardiology.
The investigators assessed 15,456 patients with stable CHD from a substudy of the STABILITY trial and followed them for an average of 3.7 years. CHD was defined as prior MI, prior coronary revascularization or multivessel CHD without revascularization. In a questionnaire, patients were asked to self-disclose lifestyle and psychosocial factors as well as how many teeth they had: 26 to 32 (all), 20 to 25, 15 to 19, one to 14 or no teeth.
The patients with a high level of tooth loss were typically older, smokers, female, less active and had a lower education level. They were also more likely to have diabetes, higher BP and a higher BMI.
The primary endpoint was major CV events, a composite of CV death, MI and stroke. Secondary endpoints included nonfatal/fatal MI, nonfatal/fatal stroke, CV death and all-cause mortality. Cox regression models were used to adjust for CV risk factors and socioeconomic status. At the end of the follow up, the researchers recorded 1,543 major CV events, 705 CV deaths, 1,120 all-cause deaths and 301 strokes.
According to the researchers, each increase in level of tooth loss was associated with:
- a 6% increased risk for major CV events (HR = 1.06; 95% CI, 1.02–1.1);
- a 17% increased risk for CV death (HR = 1.17; 95% CI, 1.1-1.24);
- a 16% increased risk for all-cause death (HR = 1.16; 95% CI, 1.11–1.22); and
- a 14% increased risk for stroke (HR = 1.14; 95% CI, 1.04–1.24).
The same association was not observed, however, with nonfatal/fatal MI (HR = 0.99; 95% CI, 0.94–1.05).
When comparing patients with no teeth to those with all teeth, the researchers found that patients with no teeth had a 27% increased risk for the primary endpoint, 85% increased risk for CV death, 81% increased risk for all-cause death and 67% increased risk for stroke.
According to the researchers, one of the most common causes of tooth loss is gum disease, and the inflammation caused by gum disease may activate the atherosclerotic process.
“This was as observational study so we cannot conclude that gum disease directly causes adverse events in heart patients,” Ola Vedin, MD, a cardiologist at Uppsala University Hospital and Uppsala Clinical Research Center in Uppsala, Sweden, said in a press release. “But tooth loss could be an easy and inexpensive way to identify patients at higher risk who need more intense prevention efforts. While we can’t yet advise patients to look after their teeth to lower their cardiovascular risk, the positive effects of brushing and flossing are well established. The potential for additional positive effects on cardiovascular health would be a bonus.” – by Tracey Romero
Disclosure: Vedin reports receiving an institutional research grant from GlaxoSmithKline during the study, and lecture/consultant fees from Fresenius and Novartis, separate from this study. See full study for the other authors’ relevant financial disclosures.