Tooth loss, hypertension and risk for stroke in a Korean population
Introduction
Stroke is one of the most common causes of death worldwide, particularly in Asia where established risk factors, including older age, hypertension, diabetes, obesity, cigarette smoking, and heavy alcohol consumption [1], [2], are common. Recent reviews have suggested that infections may be risk factors for stroke [3], [4]. Two case–control studies [5], [6] and four longitudinal studies [7], [8], [9], [10] have evaluated the association between oral conditions and stroke, and four of the six have found significant associations.
Although many epidemiological studies have addressed these and other stroke risk factors, there has been limited exploration of the combined effects of these exposures, reflecting the limitations posed by the study sizes and exposure data available in the studies carried out to date. Synergism among such common factors as tooth loss, hypertension, diabetes, and cigarette smoking would have substantial public health and clinical relevance because it would place some individuals at extremely high risk.
The authors are conducting a prospective cohort study of the causes of cancer and atherosclerotic cardiovascular diseases in a cohort of 1.3 million Koreans, also known as the Korean Cancer Prevention Study (KCPS). The participants were initially identified by their participation in a routine clinical examination carried out by the National Health Insurance Corporation [11]. Of the 1.3 million patients, over 860,000 participants had a record of tooth loss between 1992 and 1995. In this paper, we address the relationship between the number of teeth lost and risk for stroke in this subgroup of the KCPS.
Section snippets
Study population
The KCPS is a cohort study designed to assess risk factors for mortality and morbidity from all causes, atherosclerotic and cardiovascular diseases (ASCVD), and cancer as well as medical morbidity. This analysis is based on a subset of KCPS participants with recorded tooth loss. The development of this cohort from participants in the Korea Medical Insurance Corporation has been described elsewhere [11], [12]. In brief, the cohort was selected from government employees, teachers, and dependents
Results
The cohort included 867,256 participants aged 30 and over at study entry who were followed up for a total of 11,078,892 person-years with a median follow-up of 13.9 years. The population was mostly middle-aged, with approximately four times as many men as women. The mean age at baseline was 43.1 years for men and 42.6 years for women (Table 1). Males were much more likely to be current smokers (59.6%) than women (2.2%) and were also more likely to drink alcohol (78.5% compared to 15.0%).
Tooth
Discussion
In this large prospective cohort study of Korean men and women, we documented that hypertension, diabetes, cigarette smoking, and tooth loss are independent risk factors for stroke in men and women. There was evidence for interaction among tooth loss and hypertension, particularly for hemorrhagic stroke.
Recent studies have suggested that several systemic conditions, such as obesity, hypertension, hyperlipidemia, and diabetes, are related to periodontitis [1], [2]. The present results are
Acknowledgments
We thank the staff of the Korean National Health Insurance Corporation, who provided the data for this study.
Sources of funding: This study was funded by the Seoul City R&BD program (10526).
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