Tooth loss is independently associated with poor outcomes in stable coronary heart disease

Abstract

In this large global cohort of patients with coronary heart disease, self-reported tooth loss predicted adverse cardiovascular outcomes and all-cause death independent of cardiovascular risk factors and socioeconomic status.

Associations between tooth loss and prognostic biomarkers and the risk for cardiovascular events in patients with stable coronary heart disease

“…Conversely to the association with NT-proBNP, tooth loss did not appear to be related to 13 781 782 783 784 785 786 787 788 789 790 791 792 793 794 795 796 797 798 799 800 801 802 803 804 805 806 807 808 809 810 811 812 813 814 815 816 817 818 819 820 821 822 823 824 825 826 827 828 829 830 831 832 833 834 835 836 837 838 839 840 mechanisms generating elevated levels of troponin [30], which is an interesting finding concurrent with the absent association between tooth loss and MI in this population [4].…”

“…Baseline blood samples were obtained and patients reported their number of teeth according to the following tooth loss levels: "26-32 (All)" [lowest level], [20][21][22][23][24][25][15][16][17][18][19][1][2][3][4][5][6][7][8][9][10][11][12][13][14]and "No Teeth" [highest level]. Linear and Cox regression models assessed associations between tooth loss levels, biomarker levels and the relationship between tooth loss levels and outcomes, respectively.…”

“…Geometric mean ratios are presented with 95% confidence intervals (CI) with the lowest tooth loss level (26)(27)(28)(29)(30)(31)(32) replacing significant renal dysfunction) [16], hemoglobin, white blood cells, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides. Cox proportional hazards models were used to calculate hazard ratios for MACE, CV death and stroke in relation to tooth loss levels, adjusting for biomarkers in addition to a previously reported multivariable model [4], co-variables of which are also listed in Table 3. In these models, all biomarkers except Lp-PLA 2 activity were added after log-transformation.…”

“…The data up until Model 2 have been previously presented [4] showing a relative risk increase of 1.06, 1.17 and 1.14 for MACE, CV death and for stroke, respectively, for every one-level increase in tooth loss. The subsequent addition of biomarkers, individually and in groups, only attenuated the results slightly.…”

“…We have recently reported an association between tooth loss and cardiovascular (CV) outcomes, but not myocardial infarction (MI), in a chronic CHD population [4]. In the literature, the hypothesized relationship between dental disease and CV disease is often attributed to deleterious effects of periodontal disease (PD), a highly prevalent chronic inflammatory condition ranging from early gingivitis to end-stage tooth loss, on the atherosclerotic process but the specific mechanistic nature of such a relationship remains elusive and debated [5].…”