Tooth loss, diet and cardiovascular disease: A longitudinal study in middle-aged Australian women

Background and objectiveCardiovascular disease (CVD) is highly prevalent affecting one in six Australians. Tooth loss has consistently been associated with an increased risk of CVD, influenced by social determinants of health as well as effects on chewing function and diet. However, there is little evidence regarding the role of diet on the relationship between tooth loss and CVD. This study aimed to determine the impact of retaining a functional dentition (minimum of 20 teeth) on the risk of incident CVD and the role of diet in this relationship. MethodsThis prospective cohort study recruited Australian women from the 1946-51 cohort of the Australian Longitudinal Study on Womens Health. Tooth loss and diet quality were assessed from survey 5 (2007) and incident CVD from linked data over a 17-year follow-up period (2024). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for known risk factors (age, sociodemographic, lifestyle and medical history factors). ResultsA total of 8306 women, average age 58.5 {+/-} 1.5 years, 69.2% with a functional dentition were included. Over the 17-year follow-up period 1432 (17.2%) women developed incident CVD. The presence of a functional dentition was associated with a lower risk of incident CVD compared to women with a non-functional dentition, 15.5% vs 21.1% respectively, [HR 0.83 (95% CI 0.74, 0.93)]. A greater proportion of women with a functional dentition had a high-quality diet score, compared to those with a non-functional dentition (42% vs 36%, p <0.001). Controlling for diet quality did not attenuate this association [HR 0.82 (95% CI 0.73, 0.92)]. ConclusionAlthough tooth loss negatively impacts diet quality, dietary changes alone do not explain why tooth loss is a marker of incident CVD and loss of a functional dentition should prompt cardiovascular prevention action. What is already known on this topicO_LIPrevious studies have shown consistent associations between tooth loss and both a higher risk of cardiovascular disease, and poor diet quality. The role of diet in the relationship between tooth loss and cardiovascular disease is unclear. C_LI What this study addsO_LIThis prospective analysis of 8306 Australian women shows that maintaining a functional dentition (minimum 20 teeth) is associated with a lower risk of incident cardiovascular disease. C_LIO_LIRetaining teeth as part of a functional dentition is associated with a better diet quality. C_LIO_LIThe relationship between tooth loss and cardiovascular disease is not attenuated when adjusted for diet. C_LI How this study might affect research, practice or policyO_LILoss of a functional dentition should serve as a trigger for cardiovascular preventive measures C_LIO_LIDietary changes alone do not explain why tooth loss is a marker of incident cardiovascular disease, further research on the role of systemic inflammation is required. C_LI