History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women

This research was originally published in 2017 by Michael J. LaMonte, Robert J. Genco, Kathleen M. Hovey, Robert B. Wallace, Jo L. Freudenheim, Dominique S. Michaud, Xiaodan Mai, Lesley F. Tinker, Christian R. Salazar, Christopher A. Andrews, Wenjun Li, Charles B. Eaton, Lisa W. Martin, and Jean Wactawski‐Wende. 

We have curated this article as a reference point for The Larkin Protocol.



Few studies have reported associations between periodontitis and cardiovascular disease (CVD) risk in older women, which is the objective of the present investigation.

Methods and 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, interaction P=0.004) annually.


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.

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