Choe Heon, Kim Young Ho, Park Ji Wan, Kim Su Young, Lee Sang-Yi, Jee Sun Ha
Department of Hospital Management, Eul Ji University, Daejeon, Republic of Korea.
Atherosclerosis. 2009 Apr;203(2):550-6. doi: 10.1016/j.atherosclerosis.2008.07.017. Epub 2008 Jul 26.
Tooth loss has been suggested as a potential risk factor for stroke. We conducted a prospective cohort study of stroke in Korea on hypertension, diabetes, smoking, and tooth loss to characterize their independent effects and interactions. The overall risk of stroke and the risk of different subtypes of stroke were evaluated in relation to tooth loss using Cox proportional hazards models among 867,256 Korean men and women, aged 30-95 years, who received health insurance from the National Health Insurance Corporation and were medically evaluated between 1992 and 1995, with tooth loss measured. The overall prevalence of having at least one tooth removed among the people in the study was 29.8% (31.9% for men and 22.3% for women). During a 14-year follow-up, 28,258 strokes with 5105 fatal strokes occurred. For men and women, tooth loss was associated with total stroke and stroke subtypes. In a multivariable model adjusting for selected covariates, a graded association between higher tooth loss and higher risk of total stroke was observed in men [> or =7 lost teeth versus 0 (hazard ratio (HR)=1.3; 95% confidence interval (CI), 1.2-1.4)] and in women (HR=1.2; 95% CI, 1.0-1.3). The HRs for ischemic and hemorrhagic stroke were also similar in men and women. There was evidence of interaction of hemorrhagic stroke risk with hypertension and tooth loss. Tooth loss is independently associated with increased risk of stroke and hypertension does interact antagonistically, particularly for hemorrhagic stroke.
牙齿脱落被认为是中风的一个潜在风险因素。我们在韩国开展了一项关于中风的前瞻性队列研究，涉及高血压、糖尿病、吸烟和牙齿脱落，以确定它们的独立作用和相互作用。在867,256名年龄在30 - 95岁之间、参加了国民健康保险公团健康保险且在1992年至1995年期间接受过医学评估并测量了牙齿脱落情况的韩国男性和女性中，使用Cox比例风险模型评估了与牙齿脱落相关的中风总体风险以及不同亚型中风的风险。研究人群中至少拔除一颗牙齿的总体患病率为29.8%（男性为31.9%，女性为22.3%）。在14年的随访期间，发生了28,258例中风，其中5105例为致命性中风。对于男性和女性，牙齿脱落与总体中风及中风亚型相关。在调整了选定协变量的多变量模型中，在男性[≥7颗牙齿脱落与0颗牙齿脱落相比（风险比(HR)=1.3；95%置信区间(CI)，1.2 - 1.4）]和女性（HR=1.2；95% CI，1.0 - 1.3）中均观察到牙齿脱落越多与总体中风风险越高之间存在分级关联。男性和女性缺血性和出血性中风的HR也相似。有证据表明出血性中风风险与高血压和牙齿脱落之间存在相互作用。牙齿脱落与中风风险增加独立相关，并且高血压具有拮抗作用，特别是对于出血性中风。
