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HomeA FocusLosing teeth in middle-age linked to CVD risk

Losing teeth in middle-age linked to CVD risk

CardiovascularLosing two or more teeth in middle-age is associated with increased cardiovascular disease risk, according to preliminary research presented at the American Heart Association's Epidemiology and Prevention/Lifestyle and Cardiometabolic Health Scientific Sessions 2018, a premier global exchange of the latest advances in population based cardiovascular science for researchers and clinicians.

Studies have shown that dental health problems, such as periodontal disease and tooth loss, are related to inflammation, diabetes, smoking and consuming less healthy diets, according to study author Dr Lu Qi, professor of epidemiology at Tulane University in New Orleans.

"Previous research has also found that dental health issues are associated with elevated risk of cardiovascular disease," Qi said. "However, most of that research looked at cumulative tooth loss over a lifetime, which often includes teeth lost in childhood due to cavities, trauma and orthodontics. Tooth loss in middle age is more likely related to inflammation, but it hasn't been clear how this later-in-life tooth loss might influence cardiovascular disease risk."

In a collaborative research effort between Tulane University School of Public Health and Tropical Medicine and Harvard TH Chan School of Public Health, Qi and colleagues analysed the impact of tooth loss in large studies of adults, aged 45 to 69 years, in which participants had reported on the numbers of natural teeth they had, then in a follow-up questionnaire, reported recent tooth loss. Adults in this analysis didn't have cardiovascular disease when the studies began. The researchers prospectively studied the occurrence of tooth loss during an eight-year period and followed an incidence of cardiovascular disease among people with no tooth loss, one tooth lost and two or more teeth lost over 12-18 years.

They found: among the adults with 25 to 32 natural teeth at the study's start, those who lost two or more teeth had a 23% increased risk of cardiovascular disease, compared to those with no tooth loss; the increased risk occurred regardless of reported diet quality, physical activity, body weight and other cardiovascular risk factors, such as high blood pressure, high cholesterol and diabetes; there wasn't a notable increase in cardiovascular disease risk among those who reported losing one tooth during the study period; cardiovascular disease risk among all the participants (regardless of the number of natural teeth at the study's start) increased 16% among those losing two or more teeth during the study period, compared to those who didn't lose any teeth; and adults with less than 17 natural teeth, versus 25 to 32, at the study's start, were 25% more likely to have cardiovascular disease.

"In addition to other established associations between dental health and risk of disease, our findings suggest that middle-aged adults who have lost two or more teeth in recent past could be at increased risk for cardiovascular disease," Qi said. "That's regardless of the number of natural teeth a person has as a middle-aged adult, or whether they have traditional risk factors for cardiovascular disease, such as poor diet or high blood pressure."

Armed with the knowledge that tooth loss in middle age can signal elevated cardiovascular disease risk, adults can take steps to reduce the increased risk early on, he said.

A limitation of the study was that participants self-reported tooth loss, which could lead to misclassification in the study, according to Qi.

Introduction: Dental health problems such as tooth loss are related to inflammation and detrimental dietary changes and may be linked to elevated risks of future heart disease. Most previous studies only investigated pre-existing tooth loss at baseline; hence, whether incident (more recent and later in life) tooth loss is associated with an increased risk of future coronary heart disease (CHD) remains unclear.
Hypothesis: We prospectively investigated how recent tooth loss was associated with subsequent risk of CHD in middle-aged adults.
Methods: This prospective study included women from the Nurses’ Health Study (NHS) and men from the Health Professionals Follow-Up Study (HPFS) who were initially free of CHD and cancer. Participants were asked about the number of natural teeth first in 1986 in the HPFS, and in 1992 in the NHS. On follow-up questionnaires, participants reported whether they had any recent tooth loss. We calculated cumulative tooth loss during an 8-year assessment period (1992-2000 in the NHS; 1986-1998 in the HPFS) among participants aged 45-69 y. Hazard ratios (HRs) for the incidence of CHD (fatal CHD or non-fatal MI) were examined across categories of the number of tooth loss (none, 1 loss, and 2 or more loss). Follow-up time was calculated after the assessment of tooth loss until the end of follow-up in 2012. We examined risks of CHD separately among individuals with 25-32 natural teeth at the initial examination (n=41939, among whom 1754 incident cases of CHD accrued during 540,744 person-years of follow-up), as well as among all eligible participants (n=60967, among whom 2440 incident cases of CHD accrued during 760,351 person-years of follow-up).
Results: Among participants with 25-32 natural teeth at baseline, men and women who lost 2 or more teeth had a significantly increased risk of CHD (Pooled: HR 1.23; 95% CI: 1.06, 1.42) as compared to those with no tooth loss, after adjustment for hypertension, dyslipidemia, diabetes, dietary habits (including the Alternative Healthy Eating Index (AHEI) score, alcohol, multivitamin supplement use), lifestyle and demographic factors. The association was also independent of concurrent changes (during the same period of tooth loss assessment) in AHEI score, physical activity, body weight, and status of hypertension, dyslipidemia, and diabetes (pooled HR 1.22, 95% CI: 1.06, 1.41). When we examined the risk of CHD among all the eligible participants, greater loss of teeth (2 or more loss vs. no loss: pooled HR: 1.16; 95% CI: 1.04, 1.30) and having fewer natural teeth (less than 17 vs. 25-32 teeth: pooled HR: 1.25; 95% CI: 1.08, 1.46) were independently and significantly associated with increased risk of CHD.
Conclusions: Our results suggest that among middle-aged adults, a higher number of teeth lost in the recent past may be associated with subsequent risk of CHD, independent of the baseline number of natural teeth and traditional risk factors.

Yoriko Heianza, Dianjianyi Sun, Eric B Rimm, JoAnn E Manson, Kaumudi J Joshipura, Lu Qi

[link url=""]American Heart Association material[/link]
[link url=""]AHA Scientific Sessions abstract[/link]

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