牙髓治疗与心血管疾病事件：动脉粥样硬化风险社区（ARIC）研究。
Endodontic therapy and incident cardiovascular disease: The Atherosclerosis Risk in Communities (ARIC) study.
机构信息
Department of Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro, GA, USA.
Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
出版信息
J Public Health Dent. 2020 Jan;80(1):79-91. doi: 10.1111/jphd.12353. Epub 2020 Jan 21.
OBJECTIVES
Previous studies on a potential association between endodontic infection (EI) and cardiovascular disease (CVD) produced mixed results. Endodontic treatment (ET) may also be linked to cardiovascular risk, as a marker for prior chronic dental infection and subclinical EI in other teeth. We tested the hypothesis that ET is associated with elevated risk of coronary heart disease (CHD), ischemic stroke (IS), heart failure (HF), or venous thromboembolism (VTE).
METHODS
ARIC participants who completed the dental ancillary study exam 4 (1996-1998; n = 6,638) were included in the analyses. Participants were followed through 2013 for CHD, stroke, and HF and 2011 for VTE. Cox-proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for CHD, IS, HF, and VTE across ET classifications adjusting for age, sex, race/center, education, income, smoking, alcohol consumption, BMI, statin use, family history of CHD, physical activity, diet quality, insurance status, last dental visit, dental visit frequency, having a current dentist, and tooth loss due to gum disease.
RESULTS
Among participants, 21.0% reported a single ET, while 28.5% reported multiple ETs. Over a median of 15.8 years of follow-up, there were 506 incident CHD events, 311 IS events, 739 HF events, and 219 VTE events. There were no significant associations between self-reported history of ET and any of our outcomes (HR (95%CI): CHD = 1.16 (0.87,1.44), IS = 0.77 (0.55,1.09), HF = 1.00 (0.81,1.24), VTE = 0.98 (0.67,1.43)) after adjustment.
CONCLUSIONS
Our results do not support an independent association between ET and development of CHD, IS, HF, or VTE.
目的
先前关于牙髓感染（EI）与心血管疾病（CVD）之间潜在关联的研究结果不一。牙髓治疗（ET）也可能与心血管风险相关，因为它是先前慢性牙周感染和其他牙齿亚临床 EI 的标志物。我们检验了 ET 与冠心病（CHD）、缺血性中风（IS）、心力衰竭（HF）或静脉血栓栓塞（VTE）风险升高相关的假设。
方法
纳入完成了口腔附加研究检查 4（1996-1998 年；n=6638）的 ARIC 参与者进行分析。参与者通过 2013 年随访 CHD、中风和 HF，通过 2011 年随访 VTE。使用 Cox 比例风险回归模型估计 ET 分类下 CHD、IS、HF 和 VTE 的风险比（HR）和 95%置信区间（CI），调整年龄、性别、种族/中心、教育、收入、吸烟、饮酒、BMI、他汀类药物使用、CHD 家族史、身体活动、饮食质量、保险状况、最近的牙科就诊、牙科就诊频率、有现任牙医和因牙龈疾病导致的牙齿缺失。
结果
在参与者中，21.0%报告单次 ET，28.5%报告多次 ET。在中位随访 15.8 年期间，发生了 506 例 CHD 事件、311 例 IS 事件、739 例 HF 事件和 219 例 VTE 事件。在调整后，自我报告的 ET 史与任何结局均无显著关联（HR（95%CI）：CHD=1.16（0.87，1.44），IS=0.77（0.55，1.09），HF=1.00（0.81，1.24），VTE=0.98（0.67，1.43））。
结论
我们的结果不支持 ET 与 CHD、IS、HF 或 VTE 发展之间存在独立关联。
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