Seoul National University Hospital, Seoul, Republic of Korea.
Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
PLoS One. 2024 Aug 2;19(8):e0308250. doi: 10.1371/journal.pone.0308250. eCollection 2024.
While studies have suggested an association between periodontal disease and an increased risk of cardiovascular disease, the strength of this association and its specific links to various types of cardiovascular disease have not been thoroughly investigated. This study aimed to examine how gingivitis and tooth loss affect cardiovascular diseases, probing their individual impacts.
A retrospective cohort study was conducted, encompassing 3,779,490 individuals with no history of cardiovascular disease, utilizing data from the National Health Examination and the Korean National Health Insurance database from 2006 to 2019. Cox proportional hazards models were applied to estimate the association between tooth loss, gingivitis, and cardiovascular disease.
Following a median follow-up of 10.38 years, 17,942 new cardiovascular disease cases were identified, comprising 10,224 cases of angina pectoris, 6,182 cases of acute myocardial infarction, and 9,536 cases of stroke. It was observed that the risk of stroke was significantly higher in the tooth loss group compared to the control group (adjusted hazard ratio [aHR]: 1.09, 95% confidence interval [CI]: 1.04-1.15). In the group with gingivitis and tooth loss, the risk of stroke and cardiovascular disease was significantly higher than in the control group (aHR: 1.12, 95% CI: 1.04-1.20; aHR: 1.08, 95% CI: 1.03-1.14). The gingivitis group exhibited a higher risk associated with stroke (aHR: 1.05, 95% CI: 1.01-1.10) among individuals aged 50 and above. However, statistically significant associations between periodontal disease and angina pectoris were not observed, nor between periodontal disease and acute myocardial infarction except among those aged above 50. Furthermore, the association between periodontal disease and cardiovascular disease was found to be stronger among individuals over the age of 50, males, those with obesity, and smokers compared to the control group.
Our results emphasize the association of tooth loss and gingivitis with cardiovascular disease, specifically stroke, underlining the critical need for preventive oral healthcare. Tailored interventions are necessary to reduce the heightened risk of cardiovascular disease events, especially stroke, among older, obese individuals and smokers.
尽管有研究表明牙周病与心血管疾病风险增加之间存在关联，但这种关联的强度及其与各种心血管疾病的具体联系尚未得到充分研究。本研究旨在探讨牙龈炎和牙齿缺失如何影响心血管疾病，探究它们各自的影响。
采用回顾性队列研究，纳入了 2006 年至 2019 年期间无心血管疾病史的 3779490 名个体，来自国家健康检查和韩国国家健康保险数据库的数据。应用 Cox 比例风险模型估计牙齿缺失、牙龈炎与心血管疾病之间的关联。
中位随访 10.38 年后，共发现 17942 例新发心血管疾病，包括心绞痛 10224 例、急性心肌梗死 6182 例和脑卒中 9536 例。结果显示，与对照组相比，牙齿缺失组发生脑卒中的风险显著升高（调整后的风险比[aHR]：1.09，95%置信区间[CI]：1.04-1.15）。在同时患有牙龈炎和牙齿缺失的组中，发生脑卒中及心血管疾病的风险显著高于对照组（aHR：1.12，95%CI：1.04-1.20；aHR：1.08，95%CI：1.03-1.14）。在 50 岁及以上人群中，牙龈炎组发生脑卒中的风险更高（aHR：1.05，95%CI：1.01-1.10）。然而，牙周病与心绞痛之间以及牙周病与急性心肌梗死之间（50 岁以上人群除外）并未观察到统计学显著关联。此外，与对照组相比，牙周病与心血管疾病的关联在 50 岁以上人群、男性、肥胖者和吸烟者中更为显著。
本研究结果强调了牙齿缺失和牙龈炎与心血管疾病（特别是脑卒中）之间的关联，突出了进行预防性口腔保健的重要性。需要针对年龄较大、肥胖和吸烟的人群采取有针对性的干预措施，以降低心血管疾病事件（尤其是脑卒中）的风险。
