title: History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women.
abstract: BACKGROUND
  Few studies have reported associations between periodontitis and cardiovascular disease (CVD) risk in older women, which is the objective of the present investigation.
  
  
  RESULTS
  Participants were 57 001 postmenopausal women ages 55 to 89 years (mean 68 years; >85% 60 and older) who were enrolled (1993-1998) in the Women's Health Initiative Observational Study, and were without known CVD when history of periodontitis and edentulism was assessed by questionnaire at study Year-5 (1998-2003). There were 3589 incident CVD events and 3816 total deaths during a mean follow-up of 6.7 years. In multivariable analysis, periodontitis was not associated with CVD events, but was associated with higher total mortality (hazard ratio (HR)=1.12, 95% CI: 1.05-1.21). Edentulism was associated with higher age- and smoking-adjusted risks of CVD (HR=1.42, 95% CI: 1.27-1.59) and mortality (HR=1.47, 95% CI: 1.32-1.63). Further adjustment eliminated the association with CVD, but mortality remained significantly increased (HR=1.17, 95% CI: 1.02-1.33). Stratification on age, race-ethnicity, smoking, and diabetes mellitus yielded comparable results; however, edentulism was more strongly associated with CVD in women reporting ≥1 dental visit (HR=1.57) compared with <1 visit (HR 1.03, interactionP=0.004) annually.
  
  
  CONCLUSIONS
  In community-dwelling older women, edentulism was associated with increased risks of CVD and total mortality, and presence of periodontitis, which is more prevalent than edentulism, was associated with 17% higher mortality rate. These findings suggest that improving periodontal condition of the general population could reduce overall mortality.
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, NY malmaonte@buffalo.edu.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: LaMonte
authors.affiliation: Department of Oral Biology, University at Buffalo, NY.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Genco
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, NY.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Hovey
authors.affiliation: Department of Epidemiology, University of Iowa, Iowa City, IA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Wallace
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, NY.
authors.forename: Jo L
authors.initials: JL
authors.lastname: Freudenheim
authors.affiliation: Department of Public Health and Community Medicine, Tufts University, Boston, MA.
authors.forename: Dominique S
authors.initials: DS
authors.lastname: Michaud
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, NY.
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Mai
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Lesley F
authors.initials: LF
authors.lastname: Tinker
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Christian R
authors.initials: CR
authors.lastname: Salazar
authors.affiliation: Department of Ophthalmology, University of Michigan, Ann Arbor, MI.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Andrews
authors.affiliation: Department of Preventive and Behavioral Medicine, University of Massachusetts, Worcester, MA.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.affiliation: Departments of Family and Preventive Medicine and Epidemiology, Brown University, Providence, RI.
authors.forename: Charles B
authors.initials: CB
authors.lastname: Eaton
authors.affiliation: Department of Cardiology, The George Washington University, Washington, DC.
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Martin
authors.affiliation: Department of Epidemiology and Environmental Health, University at Buffalo, NY.
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D057187:Independent Living; D008875:Middle Aged; D009026:Mortality; D009066:Mouth, Edentulous / Q000453:epidemiology*; D015999:Multivariate Analysis; D010518:Periodontitis / Q000453:epidemiology*; D017698:Postmenopause; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology*
keywords: cardiovascular disease; epidemiology; mortality; periodontal disease; women's health