title: Gender differences in the relationship between periodontal disease, tooth loss, and atherosclerosis.
abstract: OBJECTIVE
  Males carry a disproportionate burden of cardiovascular disease. Because males also bear a higher burden of periodontal disease, we investigated the existence of gender differences in the postulated relationship between periodontal infections, tooth loss, and subclinical atherosclerosis.
  
  
  METHODS
  A total of 1710 randomly enrolled participants between the ages of 45 and 75 with no history of myocardial infarction or stroke received a clinical periodontal examination, carotid scan using high-resolution B-mode ultrasound, and extensive measurements for conventional cardiovascular risk factors (age, education, smoking, alcohol, body mass index, diabetes, systolic blood pressure, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglycerides) as well as markers of healthy lifestyle and social network.
  
  
  RESULTS
  In both genders, measures of current and long-term periodontitis worsened as tooth loss increased. In males but not females, an approximately 10% difference in carotid artery plaque prevalence was observed between the lowest and highest tertiles of tooth loss (P<0.05) and long-term periodontitis (P=0.05) after multivariate adjustment. Similar patterns were observed for intima-media thickness. The influence of gender on carotid artery plaque prevalence was most evident among the younger age group (<59 years). Between genders, carotid plaque prevalence differed by 10%, 15%, and 25% across increasing levels of tooth loss, and by 5%, 15%, and 25% across increasing levels of long-term periodontitis.
  
  
  CONCLUSIONS
  Our data suggest that tooth loss and long-term periodontitis are related to subclinical atherosclerosis in men but not women. Gender variations in cardiovascular morbidity or mortality may be explained partly by the differential contributions of novel risk factors across genders.
authors.affiliation: Division of Epidemiology, School of Public Health, University of Minnesota, USA.
authors.forename: Moïse
authors.initials: M
authors.lastname: Desvarieux
authors.forename: Christian
authors.initials: C
authors.lastname: Schwahn
authors.forename: Henry
authors.initials: H
authors.lastname: Völzke
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Demmer
authors.forename: Jan
authors.initials: J
authors.lastname: Lüdemann
authors.forename: Christof
authors.initials: C
authors.lastname: Kessler
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.forename: Ulrich
authors.initials: U
authors.lastname: John
authors.forename: Thomas
authors.initials: T
authors.lastname: Kocher
mesh_terms: D000368:Aged; D001161:Arteriosclerosis / Q000453:epidemiology*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene; D010518:Periodontitis / Q000453:epidemiology*; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D012944:Social Support; D016388:Tooth Loss / Q000453:epidemiology*; D014463:Ultrasonography
chemical_list: D008055:Lipids