This Study Has No Teeth: STABILITY Analysis Strengthens Link Between Periodontal, CV Disease

An analysis of more than 15,000 patients in 39 countries is providing some of the strongest data to date that periodontal disease on a backdrop of CV disease is linearly associated with increased cardiovascular disease and death.

The study, published last week in the European Journal of Preventive Cardiology, found that coronary heart disease (CHD) patients with no teeth faced almost twice the risk of death, and cardiovascular death, as those with all of their teeth intact, even after controlling for other risk factors and socioeconomic status.

Ola Vedin, MD, of University of Uppsala (Uppsala, Sweden) and colleagues analyzed prospectively collected, self-reported data on patients’ number of teeth at the outset of the STABILITY trial. (STABILITY was a large, multinational study of darapladib, which ultimately failed to show a benefit of the investigational agent on atherosclerosis.) They then correlated tooth loss, in quintiles, with risk of the primary outcome, a composite of cardiovascular death, nonfatal MI, and nonfatal stroke.

At 3.7 years, every increase in tooth-loss level was associated with an increased risk of CV death, all-cause death, and fatal or nonfatal stroke. Of note, no link was seen with MI, a finding the authors described as “puzzling.”

Compared with having all teeth, having no teeth was associated with a 27% higher risk of the primary composite outcome and a near doubling of the risk of cardiovascular death and death.

Periodontal disease has become an accepted risk factor for coronary heart disease but, according to Vedin et al, “the relationship between tooth loss and outcomes in CHD patients has not previously been evaluated in a prospective study.” Inflammation, potentially triggered by gum disease, has been hypothesized as the likely pathway, but a causative link has not been demonstrated, nor was a causative role established in the current study.

However, “self-reported tooth loss can be used to discriminate the risk of adverse events beyond that of established risk factors and socioeconomic status among patients with stable CAD,” the authors conclude.

Source: 
Vedin O, Hagstrom E, Budaj A, et al. Tooth loss is independently associated with poor outcomes in stable coronary heart disease. Eur J Prev Cardiol. 2015;Epub before print.

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