牙齿脱落可预测不良心血管转归及全因死亡

2015年12月16日，英国《欧洲预防心脏病学杂志》在线发表一项大型全球队列研究。结果显示，自我报告的牙齿脱落可预测不良心血管转归及全因死亡，并且独立于心血管危险因素和社会经济地位。

研究者对STABILITY试验中来自39个国家的近1.55万例稳定性冠心病患者（此前发生过心梗、接受过血运重建或罹患多支血管冠心病）进行研究，目的是在全球稳定性冠心病患者队列中探索自我报告的牙齿脱略与心血管转归之间的相关性。研究对基线时报告了牙齿数目（26~32颗、20~25颗、15~19颗、1~14颗以及没有牙齿）的患者进行了为期3.7年的随访。研究采用Cox回归模型校正了心血管危险因素及社会经济地位，并借此明确牙齿脱落水平（26~32：最低水平；没有牙齿：最高水平）与心血管转归间的相关性。

结果显示，校正后的牙齿脱落水平增高与主要转归（心血管死亡、非致死性心梗和非致死性卒中的组合）（HR:1.06）、心血管死亡（HR:1.17）和全因死亡（HR:1.16）以及非致死或致死性卒中（HR:1.14）危险增加相关，但与非致死或致死性心梗（HR:0.99）无关。与有26~32颗牙齿的患者相比，没有牙齿的主要转归（HR:1.27）、心血管死亡（HR:1.85）、全因死亡（HR:1.81）和卒中（HR:1.67）危险均显著增高。

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（英文原文）Tooth loss is independently associated with poor outcomes in stablecoronary heart disease

Objective We investigated associations between self-reported tooth lossand cardiovascular outcomes in a global stable coronary heart disease cohort.

Methods We examined 15,456 patients from 39 countries with stablecoronary heart disease (prior myocardial infarction, prior revascularisation ormultivessel coronary heart disease) in the STABILITY trial. At baseline,patients reported number of teeth (26–32 (all), 20–25, 15–19, 1–14 and noteeth) and were followed for 3.7 years. Cox regression models adjusted forcardiovascular risk factors and socioeconomic status, determined associationsbetween tooth loss level (26–32 teeth: lowest level; no teeth: highest level)and cardiovascular outcomes.

Results After adjustment, every increase in tooth loss level wasassociated with an increased risk of the primary outcome, the composite ofcardiovascular 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 fatalstroke (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 asignificantly 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)).

Conclusions In this large global cohort of patients with coronary heartdisease, self-reported tooth loss predicted adverse cardiovascular outcomes andall-cause death independent of cardiovascular risk factors and socioeconomicstatus.

来源：ACC CV News Digest（December 18，2015）