Association between gingivitis, tooth loss and cardiovascular risk: Insights from a 10-year nationwide cohort study of 3.7 million Koreans

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Fig 1. Flowchart of the study population.

Fig 2. Cohort study period.