title: Tooth loss is independently associated with poor outcomes in stable coronary heart disease.
abstract: We investigated associations between self-reported tooth loss and cardiovascular outcomes in a global stable coronary heart disease cohort.
  
  
  
  We examined 15,456 patients from 39 countries with stable coronary heart disease (prior myocardial infarction, prior revascularisation or multivessel coronary heart disease) in the STABILITY trial. At baseline, patients reported number of teeth (26-32 (all), 20-25, 15-19, 1-14 and no teeth) and were followed for 3.7 years. Cox regression models adjusted for cardiovascular risk factors and socioeconomic status, determined associations between tooth loss level (26-32 teeth: lowest level; no teeth: highest level) and cardiovascular outcomes.
  
  
  
  After adjustment, every increase in tooth loss level was associated with an increased risk of the primary outcome, the composite of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke (hazard ratio 1.06; 95% confidence interval 1.02-1.10), cardiovascular death (1.17; 1.10-1.24), all-cause death (1.16; 1.11-1.22) and non-fatal or fatal stroke (1.14; 1.04-1.24), but not with non-fatal or fatal myocardial infarction (0.99; 0.94-1.05). Having no teeth, compared to 26-32 teeth, entailed a significantly higher risk of the primary outcome (1.27 (1.08, 1.49)), cardiovascular death (1.85 (1.45, 2.37), all-cause death (1.81 (1.50, 2.20)) and stroke (1.67 (1.15, 2.39)).
  
  
  
  In this large global cohort of patients with coronary heart disease, self-reported tooth loss predicted adverse cardiovascular outcomes and all-cause death independent of cardiovascular risk factors and socioeconomic status.
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden ola.vedin@ucr.uu.se.
authors.forename: Ola
authors.initials: O
authors.lastname: Vedin
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Emil
authors.initials: E
authors.lastname: Hagström
authors.affiliation: Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.affiliation: Clinic of Cardiology, Medical Institute of Ministry of Interior, Sofia, Bulgaria.
authors.forename: Stephan
authors.initials: S
authors.lastname: Denchev
authors.affiliation: Department of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.affiliation: Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany Deutsches Herzzentrum München, Technische Universität München, Munich, Germany DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Koenig
authors.affiliation: Metabolic Pathways and Cardiovascular Therapeutic Area, GlaxoSmithKline, Pennsylvania, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Soffer
authors.affiliation: Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Piyamitr
authors.initials: P
authors.lastname: Sritara
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Stebbins
authors.affiliation: Green Lane Cardiovascular Service, Auckland City Hospital and University of Auckland, Auckland, New Zealand.
authors.forename: Ralph Ha
authors.initials: RH
authors.lastname: Stewart
authors.affiliation: Department of Cardioresearch, Antonius Ziekenhuis Sneek, The Netherlands.
authors.forename: Henk P
authors.initials: HP
authors.lastname: Swart
authors.affiliation: Tallinn University of Technology, North Estonia Medical Centre, Tallinn, Estonia.
authors.forename: Margus
authors.initials: M
authors.lastname: Viigimaa
authors.affiliation: University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania.
authors.forename: Dragos
authors.initials: D
authors.lastname: Vinereanu
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Wallentin
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden.
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.affiliation: Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
authors.forename: Claes
authors.initials: C
authors.lastname: Held
mesh_terms: D000368:Aged; D002423:Cause of Death / Q000639:trends; D003327:Coronary Disease / Q000150:complications / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016388:Tooth Loss / Q000150:complications / Q000453:epidemiology*
keywords: Clinical trial registration: www.clinicaltrials.gov; NCT00799903; Tooth loss; prevention; risk prediction; stable coronary heart disease