Oral-Cardiovascular Links via Blood Biomarkers: An Exposure-Wide Analysis

ObjectivesCardiovascular diseases (CVDs) remain a global health priority, with oral health linked to cardiovascular risk. However, existing studies have mainly focused on limited periodontal measures and lack analyses of multidimensional oral health. MethodsUsing data from 4,564 participants in the China Multi-Ethnic Cohort, this study employed an exposure-wide analysis to systematically examine associations between multidimensional oral health indicators and multiple CVD-related outcomes, and to evaluate the role of blood and urine-based biomarkers as potential mediators. ResultsWe found that indicators regarding caries, periodontal status, and occlusal function were significantly associated with carotid plaque prevalence. Sex-stratified analyses confirmed that all significant associations were concentrated in females, instead of males. Age-stratified analyses showed distinct patterns, with meaningful associations concentrated among participants under 65, where indicators regarding caries, periodontal status, and occlusal function were related to the FRS. In adults aged 65 and older, only the number of functional tooth units was associated with carotid plaque. Mediation analyses identified multiple blood biomarkers, including hemoglobin A1c and Platelet Large Cell Ratio, as partial mediators. ConclusionsThese findings indicate that multidimensional oral health correlates with cardiovascular outcomes, with obvious sex and age differences, and that blood biomarkers play an important mediating role. Our findings provide new insights that extend beyond traditional periodontal associations by highlighting the relevance of multidimensional oral health to cardiovascular risk, supporting its consideration in cardiovascular prevention.