CHRONIC DENTAL DISEASE AND CARDIOVASCULAR DISEASE

最近的几份报告发现， 牙周病、牙齿脱落和冠心病增加 (CHD)。龋齿与冠心病之间以及二者之间的可能联系 牙病和中风也有报道。近现代文学 也支持了其他慢性细菌和病毒的可能作用 感染、纤维蛋白原等炎症介质与冠心病的关系 风险。我们建议研究牙周病和牙周疾病之间的关系。 龋齿和牙齿脱落，以及发生冠心病的风险 并评估这些关联是否独立于共同的 风险因素包括行为因素。此外，我们建议 评估这些联系的两种可能解释：(1)牙齿 丢失会导致咀嚼效率降低，这可能会导致 减少膳食抗氧化剂和纤维的摄入量，而这反过来又是 与心血管疾病风险增加有关；以及(2) 慢性牙病可能会导致高纤维蛋白原血症 与冠心病风险增加密切相关，而且可能是因果关系。 我们还将评估C反应蛋白、von Willebrand因子、组织 纤溶酶原激活剂和因子VII作为额外的介质。 参与者包括51529名登记在卫生专业人员中的男性 1986年以来9万名女性参加护士工作的随访研究 自1976年开始进行健康研究，并于1992年报告了自己的牙齿状况。这个 在这些队列中的随访是非常好的，并且一直结束 90%。结果指标将包括冠心病的发病病例和 在男性中进行了15年的中风随访，并在 在基线水平上没有心血管疾病和癌症的妇女。超过4500人 预计会出现冠心病和中风的病例。生物标记物分析将 对由新发冠心病病例组成的人群进行检查 在首次采血时间之后，每个人有一个匹配的对照 凯斯。1989-90年间，32,000名护士提供了血液样本， 1993-94年度18,100名男性卫生专业人员 后续行动包括估计600名男性和600名男性的事件 女性中的病例进行生物标志物分析。艾滋病的高流行率 牙科感染使其与炎症性和 饮食调节因子，并最终增加冠心病和中风的风险 对数百万美国人具有重要影响。

Several recent reports have found significant associations between periodontal disease, tooth loss and increased coronary heart disease (CHD). Possible associations between dental caries and CHD and between dental disease and stroke have also been reported. Recent literature also supports the possible role of other chronic bacterial and viral infection, fibrinogen and other inflammatory mediators in increasing CHD risk. We propose to study the relation between periodontal disease, caries and tooth loss, and risk of incidence of coronary heart disease and stroke and to assess if these associations are independent of common risk factors including behavioral factors. Additionally, we propose to evaluate two possible explanations for these associations: (1) tooth loss leads to reduced masticatory efficiency, which could lead to reduced intake of dietary antioxidant and fiber, which in turn has been associated with increased risk for cardiovascular disease; and (2) chronic dental disease could lead to hyperfibrinogenemia which is strongly and probably causally associated with increased risk of CHD. We will also evaluate C-reactive protein, von Willebrand factor, tissue plasminogen activator, and Factor VII as additional mediators. Participants include 51,529 men enrolled in the Health Professionals Follow-Up Study since 1986 and 90,000 females enrolled in the Nurses Health Study since 1976 who reported their dental status in 1992. The follow-up in these cohorts is excellent and has been consistently over 90 percent. The outcome measures will include incident cases of CHD and stroke in 15 years of follow-up among men and 9 years of follow-up among women free of cardiovascular disease and cancer at baseline. Over 4500 incident cases of CHD and stroke are anticipated. Biomarker assays will be performed for a sub-population consisting of new CHD cases incident after the time of initial blood collection, and one matched control per case. Blood samples were provided by 32,000 nurses in 1989-90 and by 18,100 male health professionals in 1993-94, allowing for sufficient follow-up to include an estimated 600 incident cases among males and 600 cases among females for the biomarker analyses. The high prevalence of dental infection makes its potential association with inflammatory and dietary mediators, and ultimately increased risk of CHD and stroke very important with implications for millions of Americans.