Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Cardiology, University Heart and Vascular Center, Hamburg, Germany.
PLoS One. 2021 Nov 22;16(11):e0259652. doi: 10.1371/journal.pone.0259652. eCollection 2021.
BACKGROUND/AIM: Atrial fibrillation (AF) is a major health problem and causes heart failure and stroke. Pathophysiological mechanisms indicate a link with oral health including periodontitis (PD), but supporting data are scarce. The aim was to investigate the link between features of oral health and the prevalence of AF.
This cross-sectional analysis of the Hamburg City Health Study included 5,634 participants with complete data on their PD and AF status. AF was assessed via self-reported questionnaire or medically diagnosed by standard 12-lead resting ECG. The oral health examination included full-mouth measurements of the dental plaque index (PI), the clinical attachment loss (CAL) at 6 sites per tooth, the bleeding on probing (BOP) and the decayed, missing and filled teeth (DMFT) index. Descriptive analyses for all variables stratified by the status of PD were performed. To test for an association between prevalent PD and prevalent AF, multivariable logistic regression models were used. Mediation analysis was used to test if interleukin-6 (IL-6) and/or C-reactive protein (CRP) mediated the association between PD and AF.
Atrial fibrillation (prevalence: 5.6%) and the severity of PD (prevalence: moderate: 57.7%, severe: 18.9%) increased with age in men and women. Prevalent severe PD, CAL ≥3 mm, PI, and BOP were all associated with prevalent AF in unadjusted regression analysis. However, no association except for PI (odds ratio (OR): 1.22, 95% confidence interval (CI): 1.1-1.35, p<0.001) could be observed after adjusting for age, sex, high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), body mass index, diabetes, smoking, and educational level. Participants brushing their teeth at least twice daily had a lower AF prevalence compared with those brushing only once daily. Hs-CRP, IL-6, and the odds of AF increased as a function of PD severity grades in unadjusted analysis. However, neither the DMFT index nor IL-6 or CRP was associated with AF after adjusting for age and sex. Mediation analyses could not provide support for the hypothesis that IL-6 or CRP acted as mediator of the association between prevalent PD and prevalent AF.
The study shows an association between prevalent AF and increased dental plaque levels indicated by a higher PI. In contrast, an association of prevalent PD with prevalent AF after adjustments for several confounders could not be demonstrated. Further studies are necessary to investigate the mechanisms underlying poor oral hygiene and AF as well as the influence of improved oral hygiene on AF onset.
背景/目的：心房颤动（AF）是一个主要的健康问题，可导致心力衰竭和中风。病理生理机制表明其与口腔健康有关，包括牙周炎（PD），但支持数据很少。本研究旨在探讨口腔健康特征与 AF 患病率之间的关系。
本横断面研究分析了汉堡城市健康研究中的 5634 名参与者，这些参与者的 PD 和 AF 状态数据完整。通过自我报告问卷或标准的 12 导联静息心电图诊断 AF。口腔健康检查包括全口牙菌斑指数（PI）、每颗牙齿 6 个部位的临床附着丧失（CAL）、探诊出血（BOP）和龋齿、缺失和补牙（DMFT）指数的测量。对所有按 PD 状态分层的变量进行描述性分析。为了检验 PD 与 AF 之间是否存在关联，使用多变量逻辑回归模型。采用中介分析检验白细胞介素-6（IL-6）和/或 C 反应蛋白（CRP）是否介导 PD 与 AF 之间的关联。
在男性和女性中，AF（患病率：5.6%）和 PD 严重程度（患病率：中度：57.7%，重度：18.9%）随年龄增长而增加。未经调整的回归分析显示，严重 PD、CAL≥3mm、PI 和 BOP 均与 AF 患病率相关。然而，在调整年龄、性别、高敏 C 反应蛋白（hs-CRP）、白细胞介素-6（IL-6）、体重指数、糖尿病、吸烟和教育水平后，除 PI（比值比（OR）：1.22，95%置信区间（CI）：1.1-1.35，p<0.001）外，未观察到其他关联。每天至少刷牙两次的参与者的 AF 患病率低于每天只刷一次的参与者。在未经调整的分析中，hs-CRP、IL-6 和 AF 的可能性随着 PD 严重程度的增加而增加。然而，在调整年龄和性别后，DMFT 指数以及 IL-6 或 CRP 均与 AF 无关。中介分析不能为 PD 与 AF 之间存在关联的假设提供支持，即 IL-6 或 CRP 是 PD 与 AF 之间关联的中介。
本研究表明，AF 与较高的 PI 水平所指示的牙周炎患病率之间存在关联。相反，在调整了几个混杂因素后，PD 与 AF 之间的关联无法得到证实。需要进一步的研究来探讨口腔卫生不良与 AF 之间的潜在机制以及改善口腔卫生对 AF 发病的影响。
