History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women.
History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women.
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DOI：
10.1161/jaha.116.004518
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发表时间：
2017-03-29
影响因子：
5.4
通讯作者：
Wactawski-Wende J
中科院分区：
文献类型：
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作者：
LaMonte MJ;Genco RJ;Hovey KM;Wallace RB;Freudenheim JL;Michaud DS;Mai X;Tinker LF;Salazar CR;Andrews CA;Li W;Eaton CB;Martin LW;Wactawski-Wende J
很少有研究报道老年女性患牙周炎和心血管疾病(CVD)风险之间的关系，而心血管疾病(CVD)是本研究的目标。参与者为57-001名年龄在55岁至89岁(平均68岁；GT；85%60岁及以上)的绝经后妇女，她们参加了妇女健康倡议观察性研究(1993-1998年)，在研究第5年(1998-2003年)通过问卷调查评估牙周炎和无牙病史时，没有已知的心血管疾病。在平均6.7年的随访中，发生了3589起心血管事件，总死亡3816人。在多变量分析中，牙周炎与心血管事件无关，但与较高的总死亡率相关(风险比=1.12，95%CI：1.05~1.21)。剔牙与年龄和吸烟调整后的心血管疾病风险(HR=1.42，95%CI：1.27~1.59)和死亡率(HR=1.47，95%CI：1.32~1.63)相关。进一步的调整消除了与心血管疾病的关联，但死亡率仍显著增加(HR=1.17，95%CI：1.02~1.33)。在年龄、种族、吸烟和糖尿病方面的分层也产生了类似的结果；然而，在每年报告≥1次牙科就诊(HR=1.5 7)的女性中，与1次就诊(HR 1.03，交互作用P=0.004)相比，牙齿缺失与心血管疾病的相关性更强。在社区居住的老年妇女中，无牙齿与心血管疾病风险和总死亡率的增加有关，而牙周炎的存在比无牙齿更普遍，与17%的死亡率有关。这些发现表明，改善普通人群的牙周状况可以降低总体死亡率。
Few studies have reported associations between periodontitis and cardiovascular disease (CVD) risk in older women, which is the objective of the present investigation. 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. 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.