Tooth Loss, Gum Bleeding Tied to CV Risk Markers in Global CHD Cohort

April 15, 2014

UPPSALA, SWEDEN — Self-reported tooth loss and gum bleeding were prevalent and associated with a range of cardiometabolic and lifestyle heart-disease risk factors in a large international cohort with stable CHD[1]. Substantial tooth loss was common, with <15% remaining teeth reported by a mean 41% of the >15 000 patients, including about 16% who reported having no remaining teeth. The rates varied widely, however, across the study's 39 represented countries.

"The seemingly high prevalence in this population for tooth loss in particular illustrates a major oral health issue that may in part be due to the influence of risk factors common to both periodontal disease and CHD, such as age and smoking," note the authors, led by Dr Ola Vedin (Uppsala University, Sweden), in their April 10, 2014 report in the European Journal of Preventive Cardiology.

Their cohort consisted of the 98% of participants in the placebo-controlled Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy (STABILITY) trial who responded to a survey on dental health. The trial was primarily a test of darapladib (GlaxoSmithKline) on top of statins and other standard therapies. As recently covered by heartwire , the drug—a selective inhibitor of lipoprotein-associated phospholipase A2 (Lp-PLA2)—failed to cut the risk of CV events over a follow-up of more than three years in the patients who had been described as "high-risk." For example, 60% had a history of MI and 75% had previously undergone coronary revascularization.

The analysis joins numerous others suggesting links between poor dental health and risks of CHD and other chronic diseases. But, "To our knowledge, there are no other studies of this size and geographic scope reporting prevalence of self-reported periodontal-disease indicators and associations to CV risk in CHD patients," Vedin et al write. They caution several times that their observational study does not address whether periodontal disease is a cause of heart disease.

An April 2012 statement from the American Heart Association that was supported by the American Dental Association acknowledged observational evidence for an association between periodontal disease and vascular disease but, as heartwire reported, concluded that it was insufficient to show causation.

The 15 533 participants in the current STABILITY analysis reported their current number of remaining teeth according to the categories none, one to 14, 15 to 20, 21 to 25, or 26 to 32, as well as their frequency of gum bleeding. Fewer than 15 remaining teeth were reported by 40.9%; 16.4% reported they had no remaining teeth. Some degree of gum bleeding was reported by 25.6%.

"Tooth loss was associated with a wide range of socioeconomic and CV risk factors, with a heavier CV risk factor burden in patients with a higher degree of tooth loss," the group writes.

Relationships between Indicators of Periodontal Disease and CHD Risk Factors*

Parameter Positive Relationship Inverse Relationship
Number of remaining teeth eGFR, education level, alcohol consumption, work stress level Glucose, LDL-C, systolic BP, WBC count, waist circumference, hs-CRP, diabetes, smoking, home stress level, financial stress level
Gum bleeding LDL-C, systolic BP, education level, alcohol consumption, home stress level, financial stress level Education level, alcohol consumption, smoking
*Of those correlated in study at p<0.001; adjusted for multiple demographic, lifestyle, and socioeconomic CHD risk factors and diabetes
eGFR=estimated glomerular filtration rate
hs-CRP=high-sensitivity C-reactive protein
LDL-C=LDL cholesterol
WBC=white blood cell

The prevalence of having <15 teeth varied internationally, from the lowest rates in India (11.3%) and Norway (14.2%) to the highest in Slovakia (68.6%) and Poland (66.7%). Prevalence of gum bleeding varied from the lowest in South Africa (12.8%) to the highest in Romania (47.9%).

Although negative correlation between gum bleeding and smoking has been previously demonstrated, according to the group, some other relationships were "unexpected, such as the slightly elevated odds of higher alcohol consumption and increased work stress in patients with more teeth. Although these associations were weak and are difficult to explain without further analysis, socioeconomic factors likely play a role."

STABILITY and the current analysis were funded by GlaxoSmithKline. Vedin and eight other authors were STABILITY investigators. Disclosures for the other authors are in the report.

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