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J Am Heart Assoc. 2017 Mar 29;6(4). pii: e004518. doi: 10.1161/JAHA.116.004518.

History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women.

Author information

1
Department of Epidemiology and Environmental Health, University at Buffalo, NY malmaonte@buffalo.edu.
2
Department of Oral Biology, University at Buffalo, NY.
3
Department of Epidemiology and Environmental Health, University at Buffalo, NY.
4
Department of Epidemiology, University of Iowa, Iowa City, IA.
5
Department of Public Health and Community Medicine, Tufts University, Boston, MA.
6
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
7
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
8
Department of Ophthalmology, University of Michigan, Ann Arbor, MI.
9
Department of Preventive and Behavioral Medicine, University of Massachusetts, Worcester, MA.
10
Departments of Family and Preventive Medicine and Epidemiology, Brown University, Providence, RI.
11
Department of Cardiology, The George Washington University, Washington, DC.

Abstract

BACKGROUND:

Few studies have reported associations between periodontitis and cardiovascular disease (CVD) risk in older women, which is the objective of the present investigation.

METHODS AND RESULTS:

Participants were 57 001 postmenopausal women ages 55 to 89 years (mean 68 years; >85% 60 and older) who were enrolled (1993-1998) in the Women's Health Initiative Observational Study, and were without known CVD when history of periodontitis and edentulism was assessed by questionnaire at study Year-5 (1998-2003). There were 3589 incident CVD events and 3816 total deaths during a mean follow-up of 6.7 years. In multivariable analysis, periodontitis was not associated with CVD events, but was associated with higher total mortality (hazard ratio (HR)=1.12, 95% CI: 1.05-1.21). Edentulism was associated with higher age- and smoking-adjusted risks of CVD (HR=1.42, 95% CI: 1.27-1.59) and mortality (HR=1.47, 95% CI: 1.32-1.63). Further adjustment eliminated the association with CVD, but mortality remained significantly increased (HR=1.17, 95% CI: 1.02-1.33). Stratification on age, race-ethnicity, smoking, and diabetes mellitus yielded comparable results; however, edentulism was more strongly associated with CVD in women reporting ≥1 dental visit (HR=1.57) compared with <1 visit (HR 1.03, interaction P=0.004) annually.

CONCLUSIONS:

In community-dwelling older women, edentulism was associated with increased risks of CVD and total mortality, and presence of periodontitis, which is more prevalent than edentulism, was associated with 17% higher mortality rate. These findings suggest that improving periodontal condition of the general population could reduce overall mortality.

KEYWORDS:

cardiovascular disease; epidemiology; mortality; periodontal disease; women's health

PMID:
28356279
PMCID:
PMC5532989
DOI:
10.1161/JAHA.116.004518
[Indexed for MEDLINE]
Free PMC Article

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