Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea.
Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, South Korea.
Diabetes Metab. 2021 Nov;47(6):101252. doi: 10.1016/j.diabet.2021.101252. Epub 2021 Apr 13.
Periodontitis is a common chronic inflammatory disease prevalent in diabetes. The aim of this study was to evaluate periodontitis and poor oral hygiene as independent risk factors for either cerebral or myocardial infarction in the diabetes population.
This retrospective cohort study included 17,009 patients with diabetes who had participated in a nationwide health-screening programme, including oral health examination, during 2002-2003 in South Korea. Presence of periodontitis, tooth loss and carious teeth were assessed by professional dentists, and the number of tooth brushings per day was evaluated through self-reported questionnaires. The primary study outcome was the development of cerebral or myocardial infarction, based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes, up to 31 December 2015.
The study enrolled 17,009 patients with diabetes. Over the mean 11.64 years of follow-up, 1341 patients presented with either cerebral or myocardial infarction. On multivariable Cox proportional hazards regression analysis, presence of periodontitis was an independent risk factor for either cerebral or myocardial infarction [adjusted hazard ratio (HR): 1.17, 95% confidence interval (CI): 1.02-1.34; P = 0.030]. An increased number of carious teeth (≥5) was also associated with risk of cerebral or myocardial infarction (adjusted HR: 1.67, 95% CI: 1.20-2.32; P = 0.002), whereas frequent tooth brushing (≥2 times/day) was negatively associated with risk of cerebral or myocardial infarction (adjusted HR: 0.79, 95% CI: 0.70-0.90; P < 0.001) compared with tooth brushing ≤1 time/day.
Early identification and intervention of periodontal disease may be effective in reducing cardiovascular complications in the diabetes population, and improved oral hygiene would probably be associated with lower cardiovascular risk in diabetes.
牙周炎是一种常见的慢性炎症性疾病，在糖尿病患者中较为普遍。本研究旨在评估牙周炎和口腔卫生不良是否为糖尿病患者发生脑梗死或心肌梗死的独立危险因素。
本回顾性队列研究纳入了 2002-2003 年期间参加韩国全国健康筛查计划的 17009 例糖尿病患者，该计划包括口腔健康检查。专业牙医评估了牙周炎、牙齿缺失和龋齿的情况，通过自我报告的问卷评估了每天刷牙的次数。主要研究结果是根据国际疾病分类和相关健康问题第十次修订版（ICD-10）代码，截至 2015 年 12 月 31 日发生脑梗死或心肌梗死。
本研究共纳入 17009 例糖尿病患者。在平均 11.64 年的随访期间，1341 例患者发生脑梗死或心肌梗死。多变量 Cox 比例风险回归分析显示，存在牙周炎是脑梗死或心肌梗死的独立危险因素（调整后的危险比[HR]：1.17，95%置信区间[CI]：1.02-1.34；P=0.030）。龋齿数量增加（≥5 颗）也与脑梗死或心肌梗死的风险相关（调整后的 HR：1.67，95% CI：1.20-2.32；P=0.002），而每天刷牙次数增加（≥2 次/天）与脑梗死或心肌梗死的风险呈负相关（调整后的 HR：0.79，95% CI：0.70-0.90；P<0.001），与每天刷牙≤1 次相比。
早期识别和干预牙周病可能有助于降低糖尿病患者的心血管并发症风险，改善口腔卫生可能与降低糖尿病患者的心血管风险有关。
