Dental News - Coronary heart disease patients with no teeth have nearly double risk of death

Dental Tribune USA

Thu. 14 January 2016

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Coronary heart disease patients with no teeth have nearly double the risk of death as those with all of their teeth, according to research recently published in the European Journal of Preventive Cardiology.[1] The study with more than 15,000 patients from 39 countries found that levels of tooth loss were linearly associated with increasing death rates.

“The relationship between dental health, particularly periodontal disease, and cardiovascular disease has received increasing attention over the past 20 years,” said lead author Dr. Ola Vedin, cardiologist at Uppsala University Hospital and Uppsala Clinical Research Center in Uppsala, Sweden. “However it has been insufficiently investigated among patients with established coronary heart disease who are at especially high risk of adverse events and death and in need of intensive prevention measures.”

Analysis included 15,456 patients from 39 countries on five continents

This was the first study to prospectively assess the relationship between tooth loss and outcomes in patients with coronary heart disease (CHD). The results are from a substudy of the STABILITY trial2, which evaluated the effects of the Lp-PLA2 inhibitor darapladib versus placebo in patients with CHD.

The analysis included 15,456 patients from 39 countries on five continents from the STABILITY trial.[2] At the beginning of the study, patients completed a questionnaire about lifestyle factors (smoking, physical activity, etc), psychosocial factors and number of teeth in five categories (26-32 [considered all teeth remaining], 20-25, 15-19, 1-14 and none).

Patients were followed for an average of 3.7 years. Associations between tooth loss and outcomes were calculated after adjusting for cardiovascular risk factors and socioeconomic status. The primary outcome was major cardiovascular events (a composite of cardiovascular death, myocardial infarction and stroke).

Patients with a high level of tooth loss were older, smokers, female, less active and more likely to have diabetes, higher blood pressure, higher body mass index and lower education.

During follow up there were 1,543 major cardiovascular events, 705 cardiovascular deaths, 1,120 deaths from any cause and 301 strokes.

After adjusting for cardiovascular risk factors and socioeconomic status, every increase in category of tooth loss was associated with a 6 percent increased risk of major cardiovascular events, 17 percent increased risk of cardiovascular death, 16 percent increased risk of all-cause death and 14 percent increased risk of stroke.

746 patients had a myocardial infarction during the study

Compared with those with all of their teeth, after adjusting for risk factors and socioeconomic status, the group with no teeth had a 27 percent increased risk of major cardiovascular events, 85 percent increased risk of cardiovascular death, 81 percent increased risk of all-cause death and 67 percent increased risk of stroke.

“The risk increase was linear, with the highest risk in those with no remaining teeth,” said Vedin. “For example, the risks of cardiovascular death and all-cause death were almost double to those with all teeth remaining. Heart disease and gum disease share many risk factors such as smoking and diabetes, but we adjusted for these in our analysis and found a seemingly independent relationship between the two conditions.

“Many patients in the study had lost teeth so we are not talking about a few individuals here,” continued Vedin. “Around 16 percent of patients had no teeth and roughly 40 percent were missing half of their teeth.”

During the study period, 746 patients had a myocardial infarction. There was a numerically increased risk of myocardial infarction for every increase in tooth loss, but this was not significant after adjustment for risk factors and socioeconomic status. Vedin said, “We found no association between number of teeth and risk of myocardial infarction. This was puzzling (because) we had robust associations with other cardiovascular outcomes, including stroke.”

Tooth loss could identify patients who need more prevention efforts

Gum disease is one of the most common causes of tooth loss. The inflammation from gum disease is thought to trigger the atherosclerotic process and may explain the associations observed in the study. Poor dental hygiene is one of the strongest risk factors for gum disease.

“This was an observational study so we cannot conclude that gum disease directly causes adverse events in heart patients,” Vedin said. “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.”

(Sources: European Society of Cardiology and European Journal of Preventive Cardiology)

This article was published in Hygiene Tribune U.S. Edition, Vol. 9, No. 1, January 2016 issue.

A complete list of references is available from the publisher.

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