{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T22:54:36Z","timestamp":1772924076650,"version":"3.50.1"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T00:00:00Z","timestamp":1722556800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>While studies have suggested an association between periodontal disease and an increased risk of cardiovascular disease, the strength of this association and its specific links to various types of cardiovascular disease have not been thoroughly investigated. This study aimed to examine how gingivitis and tooth loss affect cardiovascular diseases, probing their individual impacts.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective cohort study was conducted, encompassing 3,779,490 individuals with no history of cardiovascular disease, utilizing data from the National Health Examination and the Korean National Health Insurance database from 2006 to 2019. Cox proportional hazards models were applied to estimate the association between tooth loss, gingivitis, and cardiovascular disease.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Following a median follow-up of 10.38 years, 17,942 new cardiovascular disease cases were identified, comprising 10,224 cases of angina pectoris, 6,182 cases of acute myocardial infarction, and 9,536 cases of stroke. It was observed that the risk of stroke was significantly higher in the tooth loss group compared to the control group (adjusted hazard ratio [aHR]: 1.09, 95% confidence interval [CI]: 1.04\u20131.15). In the group with gingivitis and tooth loss, the risk of stroke and cardiovascular disease was significantly higher than in the control group (aHR: 1.12, 95% CI: 1.04\u20131.20; aHR: 1.08, 95% CI: 1.03\u20131.14). The gingivitis group exhibited a higher risk associated with stroke (aHR: 1.05, 95% CI: 1.01\u20131.10) among individuals aged 50 and above. However, statistically significant associations between periodontal disease and angina pectoris were not observed, nor between periodontal disease and acute myocardial infarction except among those aged above 50. Furthermore, the association between periodontal disease and cardiovascular disease was found to be stronger among individuals over the age of 50, males, those with obesity, and smokers compared to the control group.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our results emphasize the association of tooth loss and gingivitis with cardiovascular disease, specifically stroke, underlining the critical need for preventive oral healthcare. Tailored interventions are necessary to reduce the heightened risk of cardiovascular disease events, especially stroke, among older, obese individuals and smokers.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0308250","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T17:23:30Z","timestamp":1722619410000},"page":"e0308250","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Association between gingivitis, tooth loss and cardiovascular risk: Insights from a 10-year nationwide cohort study of 3.7 million Koreans"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0007-1055","authenticated-orcid":true,"given":"Seung Yeon","family":"Lee","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,8,2]]},"reference":[{"issue":"4","key":"pone.0308250.ref001","doi-asserted-by":"crossref","first-page":"930","DOI":"10.5114\/aoms\/165962","article-title":"Burden of oral disorders, 1990\u20132019: estimates from the Global Burden of Disease Study 2019.","volume":"19","author":"C Tu","year":"2023","journal-title":"Arch Med Sci"},{"issue":"6","key":"pone.0308250.ref002","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1111\/idj.12630","article-title":"Current Concepts in the Management of Periodontitis.","volume":"71","author":"T Kwon","year":"2021","journal-title":"Int Dent J"},{"key":"pone.0308250.ref003","article-title":"2021. Most Frequent Disease Statistics","year":"2022","journal-title":"Health Insurance Review and Assessment Service"},{"key":"pone.0308250.ref004","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1111\/j.1600-0757.1994.tb00020.x","article-title":"Microbial etiological agents of destructive periodontal diseases.","volume":"5","author":"AD Haffajee","year":"1994","journal-title":"Periodontol 2000."},{"issue":"1","key":"pone.0308250.ref005","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/prd.12330","article-title":"The prevention of periodontal disease-An overview.","volume":"84","author":"FA Scannapieco","year":"2020","journal-title":"Periodontol 2000."},{"issue":"4","key":"pone.0308250.ref006","doi-asserted-by":"crossref","first-page":"e004518","DOI":"10.1161\/JAHA.116.004518","article-title":"History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women.","volume":"6","author":"MJ LaMonte","year":"2017","journal-title":"J Am Heart Assoc."},{"key":"pone.0308250.ref007","doi-asserted-by":"crossref","first-page":"c2451","DOI":"10.1136\/bmj.c2451","article-title":"Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey.","volume":"340","author":"C de Oliveira","year":"2010","journal-title":"BMJ"},{"issue":"10 Suppl","key":"pone.0308250.ref008","first-page":"1123","article-title":"Periodontal disease and cardiovascular disease.","author":"J Beck","year":"1996","journal-title":"J Periodontol."},{"issue":"3","key":"pone.0308250.ref009","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1539\/joh.L7066","article-title":"The association between self-reported periodontitis and coronary heart disease\u2014from MY Health Up Study\u2014","volume":"50","author":"T Senba","year":"2008","journal-title":"J Occup Health"},{"issue":"6","key":"pone.0308250.ref010","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1177\/2047487318759112","article-title":"Oral health and later coronary heart disease: Cohort study of one million people.","volume":"25","author":"GD Batty","year":"2018","journal-title":"Eur J Prev Cardiol"},{"issue":"2","key":"pone.0308250.ref011","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.atherosclerosis.2008.07.017","article-title":"Tooth loss, hypertension and risk for stroke in a Korean population","volume":"203","author":"H Choe","year":"2009","journal-title":"Atherosclerosis"},{"issue":"3","key":"pone.0308250.ref012","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1111\/cdoe.12752","article-title":"An examination of the risk of periodontitis for nonfatal cardiovascular diseases on the basis of a large insurance claims database.","volume":"51","author":"NGFM Beukers","year":"2023","journal-title":"Community Dent Oral Epidemiol"},{"issue":"2","key":"pone.0308250.ref013","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/S0735-1097(00)01130-X","article-title":"Periodontal disease and risk of subsequent cardiovascular disease in U.S. male physicians","volume":"37","author":"TH Howell","year":"2001","journal-title":"J Am Coll Cardiol"},{"issue":"4","key":"pone.0308250.ref014","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1016\/j.amjcard.2016.05.036","article-title":"Relation of Periodontitis to Risk of Cardiovascular and All-Cause Mortality (from a Danish Nationwide Cohort Study).","volume":"118","author":"GM Hansen","year":"2016","journal-title":"Am J Cardiol."},{"issue":"11","key":"pone.0308250.ref015","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1111\/jcpe.12471","article-title":"The association of hypertension with periodontitis is highlighted in female adults: results from the Fourth Korea National Health and Nutrition Examination Survey.","volume":"42","author":"YB Ahn","year":"2015","journal-title":"J Clin Periodontol"},{"issue":"6","key":"pone.0308250.ref016","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1111\/jcpe.13113","article-title":"Dental treatment procedures for periodontal disease and the subsequent risk of ischaemic stroke: A retrospective population-based cohort study.","volume":"46","author":"HW Lin","year":"2019","journal-title":"J Clin Periodontol"},{"issue":"2","key":"pone.0308250.ref017","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1161\/STROKEAHA.117.018990","article-title":"Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke","volume":"49","author":"S Sen","year":"2018","journal-title":"Stroke"},{"issue":"6","key":"pone.0308250.ref018","doi-asserted-by":"crossref","first-page":"e000254","DOI":"10.1161\/JAHA.113.000254","article-title":"Changes in clinical and microbiological periodontal profiles relate to progression of carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology study.","volume":"2","author":"M Desvarieux","year":"2013","journal-title":"J Am Heart Assoc"},{"issue":"20","key":"pone.0308250.ref019","doi-asserted-by":"crossref","first-page":"2520","DOI":"10.1161\/CIR.0b013e31825719f3","article-title":"Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association","volume":"125","author":"PB Lockhart","year":"2012","journal-title":"Circulation"},{"issue":"1","key":"pone.0308250.ref020","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/nri3785","article-title":"Periodontitis: from microbial immune subversion to systemic inflammation","volume":"15","author":"G. Hajishengallis","year":"2015","journal-title":"Nat Rev Immunol"},{"issue":"5","key":"pone.0308250.ref021","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1111\/j.2041-1014.2010.00582.x","article-title":"Review: Pathogen-induced inflammation at sites distant from oral infection: bacterial persistence and induction of cell-specific innate immune inflammatory pathways.","volume":"25","author":"C Hayashi","year":"2010","journal-title":"Mol Oral Microbiol"},{"issue":"9","key":"pone.0308250.ref022","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1902\/jop.2006.050405","article-title":"Periodontal disease and coronary heart disease","volume":"77","author":"K Geismar","year":"2006","journal-title":"J Periodontol"},{"issue":"25","key":"pone.0308250.ref023","first-page":"2982","article-title":"GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u20132019: Update From the GBD 2019 Study.","volume":"76","author":"GA Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"pone.0308250.ref024","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.ijcard.2015.08.172","article-title":"Worldwide disparities in cardiovascular disease: Challenges and solutions.","volume":"202","author":"IS Okwuosa","year":"2016","journal-title":"Int J Cardiol"},{"issue":"2","key":"pone.0308250.ref025","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1093\/ije\/dyh375","article-title":"Tooth loss is associated with increased risk of total death and death from upper gastrointestinal cancer, heart disease, and stroke in a Chinese population-based cohort.","volume":"34","author":"CC Abnet","year":"2005","journal-title":"Int J Epidemiol."},{"key":"pone.0308250.ref026","unstructured":"National Health Screening Act, Act No. 14462, Dec. 30, 2016. Available at: https:\/\/law.go.kr\/LSW\/lsInfoP.do?lsId=010708&ancYnChk=0#0000"},{"issue":"2","key":"pone.0308250.ref027","doi-asserted-by":"crossref","first-page":"81","DOI":"10.7570\/jomes21022","article-title":"Committee of Clinical Practice Guidelines, Korean Society for the Study of Obesity (KSSO). 2020 Korean Society for the Study of Obesity Guidelines for the Management of Obesity in Korea","volume":"30","author":"BY Kim","year":"2021","journal-title":"J Obes Metab Syndr"},{"key":"pone.0308250.ref028","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1186\/s40885-019-0121-0","article-title":"2018 Korean Society of Hypertension guidelines for the management of hypertension: part I-epidemiology of hypertension.","volume":"25","author":"HC Kim","year":"2019","journal-title":"Clin Hypertens."},{"issue":"5","key":"pone.0308250.ref029","doi-asserted-by":"crossref","first-page":"349","DOI":"10.4093\/dmj.2013.37.5.349","article-title":"Taskforce Team of Diabetes Fact Sheet of the Korean Diabetes Association. Prevalence of Diabetes and Prediabetes according to Fasting Plasma Glucose and HbA1c.","volume":"37","author":"JY Jeon","year":"2013","journal-title":"Diabetes Metab J."},{"issue":"2","key":"pone.0308250.ref030","first-page":"78","article-title":"Committee of Clinical Practice Guideline of Korean Society of Lipid and Atherosclerosis. 2018 Guidelines for the Management of Dyslipidemia in Korea","volume":"8","author":"EJ Rhee","year":"2019","journal-title":"J Lipid Atheroscler."},{"issue":"8","key":"pone.0308250.ref031","doi-asserted-by":"crossref","first-page":"e012386","DOI":"10.1136\/bmjopen-2016-012386","article-title":"Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172\u2005630 participants from the prospective 45 and Up Study.","volume":"6","author":"G Joshy","year":"2016","journal-title":"BMJ Open"},{"issue":"5","key":"pone.0308250.ref032","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1093\/aje\/kwp177","article-title":"Do genetic factors explain the association between poor oral health and cardiovascular disease? A prospective study among Swedish twins","volume":"170","author":"LA Mucci","year":"2009","journal-title":"Am J Epidemiol"},{"issue":"1","key":"pone.0308250.ref033","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1177\/204748739900600102","article-title":"Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases","volume":"6","author":"HI Morrison","year":"1999","journal-title":"J Cardiovasc Risk"},{"issue":"1","key":"pone.0308250.ref034","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1161\/01.STR.0000052974.79428.0C","article-title":"Periodontal disease, tooth loss, and incidence of ischemic stroke","volume":"34","author":"KJ Joshipura","year":"2003","journal-title":"Stroke"},{"issue":"4","key":"pone.0308250.ref035","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1161\/STROKEAHA.111.000076","article-title":"Dental prophylaxis and periodontal treatment are protective factors to ischemic stroke","volume":"44","author":"YL Lee","year":"2013","journal-title":"Stroke"},{"issue":"4","key":"pone.0308250.ref036","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1002\/ana.21742","article-title":"Periodontitis and incidence of cerebrovascular disease in men","volume":"66","author":"M Jimenez","year":"2009","journal-title":"Ann Neurol"},{"issue":"4","key":"pone.0308250.ref037","first-page":"605","article-title":"Five-year follow-up study of the association between periodontal disease and myocardial infarction among Japanese male workers: MY Health Up Study.","volume":"37","author":"S Noguchi","year":"2015","journal-title":"J Public Health (Oxf)."},{"issue":"26","key":"pone.0308250.ref038","doi-asserted-by":"crossref","first-page":"e7398","DOI":"10.1097\/MD.0000000000007398","article-title":"Association between periodontal disease and non-communicable diseases: A 12-year longitudinal health-examinee cohort study in South Korea.","volume":"96","author":"JH Lee","year":"2017","journal-title":"Medicine (Baltimore)."},{"issue":"1","key":"pone.0308250.ref039","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/jcpe.12335","article-title":"Cardiovascular risks associated with incident and prevalent periodontal disease.","volume":"42","author":"YH Yu","year":"2015","journal-title":"J Clin Periodontol"},{"issue":"6","key":"pone.0308250.ref040","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1161\/CIRCULATIONAHA.115.020324","article-title":"Periodontitis Increases the Risk of a First Myocardial Infarction: A Report From the PAROKRANK Study","volume":"133","author":"L Ryd\u00e9n","year":"2016","journal-title":"Circulation"},{"issue":"10","key":"pone.0308250.ref041","doi-asserted-by":"crossref","first-page":"e109187","DOI":"10.1371\/journal.pone.0109187","article-title":"General immune status and oral microbiology in patients with different forms of periodontitis and healthy control subjects","volume":"9","author":"J Schmidt","year":"2014","journal-title":"PLoS One"},{"key":"pone.0308250.ref042","doi-asserted-by":"crossref","first-page":"9262","DOI":"10.1038\/srep09262","article-title":"The role of activated cytotoxic T cells in etiopathogenesis of periodontal disease: does it harm or does it heal?","volume":"5","author":"E Cifcibasi","year":"2015","journal-title":"Sci Rep."},{"issue":"1","key":"pone.0308250.ref043","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.amjcard.2009.05.002","article-title":"The American Journal of Cardiology and Journal of Periodontology Editors\u2019 Consensus: periodontitis and atherosclerotic cardiovascular disease.","volume":"104","author":"VE Friedewald","year":"2009","journal-title":"Am J Cardiol"},{"issue":"7","key":"pone.0308250.ref044","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1177\/0022034520986097","article-title":"Severe Periodontal Disease Increases Acute Myocardial Infarction and Stroke: A 10-Year Retrospective Follow-up Study","volume":"100","author":"HJ Cho","year":"2021","journal-title":"J Dent Res"},{"issue":"4","key":"pone.0308250.ref045","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1159\/000202011","article-title":"Atherosclerotic carotid vulnerable plaque and subsequent stroke: a high-resolution MRI study","volume":"27","author":"T Gao","year":"2009","journal-title":"Cerebrovasc Dis"},{"issue":"9","key":"pone.0308250.ref046","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1161\/01.STR.0000136767.71518.36","article-title":"Gender differences in the relationship between periodontal disease, tooth loss, and atherosclerosis","volume":"35","author":"M Desvarieux","year":"2004","journal-title":"Stroke"},{"issue":"9","key":"pone.0308250.ref047","doi-asserted-by":"crossref","first-page":"1724","DOI":"10.1161\/01.STR.28.9.1724","article-title":"Association between acute cerebrovascular ischemia and chronic and recurrent infection","volume":"28","author":"AJ Grau","year":"1997","journal-title":"Stroke"},{"key":"pone.0308250.ref048","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1477-5751-8-6","article-title":"Number of teeth and myocardial infarction and stroke among elderly never smokers","volume":"8","author":"AM Syrj\u00e4l\u00e4","year":"2009","journal-title":"J Negat Results Biomed"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308250","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T17:23:58Z","timestamp":1722619438000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0308250"}},"subtitle":[],"editor":[{"given":"C\u00e9sar F\u00e9lix","family":"Cayo-Rojas","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2024,8,2]]},"references-count":48,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0308250","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,2]]}}}