{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T09:43:36Z","timestamp":1785923016780,"version":"3.56.0"},"reference-count":23,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Cardiovascular disease (CVD) prevention in ageing populations requires simple and clinically accessible markers that may help identify individuals at elevated risk. Tooth loss is a common oral condition in middle-aged and older adults and may reflect cumulative inflammatory burden, impaired oral function, and broader health vulnerability. However, longitudinal evidence from nationally representative populations across different countries remains limited. We investigated whether a baseline of missing teeth was independently associated with incident CVD in three nationally representative ageing cohorts from China, the United States, and England. Methods: We analyzed data from the China Health and Retirement Longitudinal Study (CHARLS), the Health and Retirement Study (HRS), and the English Longitudinal Study of Ageing (ELSA). Participants aged 45 years or older without baseline CVD and with available baseline tooth status were included. Missing teeth were assessed at baseline as a dichotomous exposure. Incident CVD was defined as newly reported heart disease and\/or stroke during follow-up. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with sequential adjustment for sociodemographic, lifestyle, and clinical covariates. Kaplan\u2013Meier, subgroup, and sensitivity analyses were also performed. Results: A total of 31,805 participants were included, comprising 13,451 from CHARLS, 11,384 from HRS, and 6970 from ELSA. During follow-up, 2336 incident CVD events occurred in CHARLS, 2914 in HRS, and 545 in ELSA. In fully adjusted models, missing teeth was associated with a higher risk of incident CVD in all three cohorts, with HRs of 1.31 (95% CI, 1.14\u20131.50) in CHARLS, 1.43 (95% CI, 1.29\u20131.57) in HRS, and 1.86 (95% CI, 1.49\u20132.31) in ELSA. Kaplan\u2013Meier analyses showed consistently lower CVD-free survival among participants with missing teeth, and the associations remained broadly robust across subgroup and sensitivity analyses. Conclusions: In three nationally representative cohorts from China, the United States, and England, a baseline of missing teeth was independently associated with a higher risk of incident CVD among middle-aged and older adults. These findings suggest that missing teeth may serve as a simple and clinically accessible marker of elevated cardiovascular risk and support greater integration of oral health into cardiovascular risk assessment and preventive strategies for ageing populations.<\/jats:p>","DOI":"10.3390\/jcm15156080","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:14:46Z","timestamp":1785917686000},"page":"6080","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Missing Teeth and Incident Cardiovascular Disease in Ageing Populations: Longitudinal Evidence from Three Nationally Representative Cohorts"],"prefix":"10.3390","volume":"15","author":[{"given":"Zeping","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"En","family":"Qiao","sequence":"additional","affiliation":[{"name":"Department of Lung Transplantation and Thoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310010, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Structural Heart Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global Burden of Cardiovascular Diseases and Risk Factors, 1990\u20132019: Update From the GBD 2019 Study","volume":"76","author":"Roth","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1177\/0022034520908533","article-title":"Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study","volume":"99","author":"Marcenes","year":"2020","journal-title":"J. Dent. Res."},{"key":"ref_3","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":"Lockhart","year":"2012","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/jcpe.13189","article-title":"Periodontitis and Cardiovascular Diseases: Consensus Report","volume":"47","author":"Sanz","year":"2020","journal-title":"J. Clin. Periodontol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S51","DOI":"10.1111\/jcpe.12060","article-title":"Inflammatory Mechanisms Linking Periodontal Diseases to Cardiovascular Diseases","volume":"40","author":"Schenkein","year":"2013","journal-title":"J. Clin. Periodontol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1111\/j.1600-0528.2005.00200.x","article-title":"The Association Between Tooth Loss and the Self-Reported Intake of Selected CVD-Related Nutrients and Foods Among US Women","volume":"33","author":"Hung","year":"2005","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Cheng, F., Zhang, M., Wang, Q., Xu, H., Dong, X., Gao, Z., Liu, D., Zhou, Y., Wang, N., and Chen, Y. (2018). Tooth Loss and Risk of Cardiovascular Disease and Stroke: A Dose-Response Meta-Analysis of Prospective Cohort Studies. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0194563"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Watt, R.G., Tsakos, G., de Oliveira, C., and Hamer, M. (2012). Tooth Loss and Cardiovascular Disease Mortality Risk\u2014Results From the Scottish Health Survey. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0030797"},{"key":"ref_9","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":"Batty","year":"2018","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"BSR20181773","DOI":"10.1042\/BSR20181773","article-title":"The Relationship Between Tooth Loss and Mortality From All Causes, Cardiovascular Diseases, and Coronary Heart Disease in the General Population: Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies","volume":"39","author":"Peng","year":"2019","journal-title":"Biosci. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Beukers, N.G.F.M., Su, N., Loos, B.G., and van der Heijden, G.J.M.G. (2021). Lower Number of Teeth Is Related to Higher Risks for ACVD and Death\u2014Systematic Review and Meta-Analyses of Survival Data. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.621626"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/ije\/dys203","article-title":"Cohort Profile: The China Health and Retirement Longitudinal Study (CHARLS)","volume":"43","author":"Zhao","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1093\/ije\/dyu067","article-title":"Cohort Profile: The Health and Retirement Study (HRS)","volume":"43","author":"Sonnega","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1093\/ije\/dys168","article-title":"Cohort Profile: The English Longitudinal Study of Ageing","volume":"42","author":"Steptoe","year":"2013","journal-title":"Int. J. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1080\/01621459.1958.10501452","article-title":"Nonparametric Estimation from Incomplete Observations","volume":"53","author":"Kaplan","year":"1958","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1111\/j.2517-6161.1972.tb00899.x","article-title":"Regression Models and Life-Tables","volume":"34","author":"Cox","year":"1972","journal-title":"J. R. Stat. Soc. Ser. B Stat. Methodol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1080\/01621459.1999.10474144","article-title":"A Proportional Hazards Model for the Subdistribution of a Competing Risk","volume":"94","author":"Fine","year":"1999","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1093\/biomet\/69.1.239","article-title":"Partial Residuals for the Proportional Hazards Regression Model","volume":"69","author":"Schoenfeld","year":"1982","journal-title":"Biometrika"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/biomet\/81.3.515","article-title":"Proportional Hazards Tests and Diagnostics Based on Weighted Residuals","volume":"81","author":"Grambsch","year":"1994","journal-title":"Biometrika"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1002\/cre2.336","article-title":"Risk of Incident Cardiovascular Disease in People with Periodontal Disease: A Systematic Review and Meta-Analysis","volume":"7","author":"Larvin","year":"2021","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1177\/00220345221120164","article-title":"Causal Effect of Tooth Loss on Cardiovascular Diseases","volume":"102","author":"Matsuyama","year":"2023","journal-title":"J. Dent. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.tcm.2023.03.003","article-title":"Oral Health as a Modifiable Risk Factor for Cardiovascular Diseases","volume":"34","author":"Altamura","year":"2024","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Arbildo-Vega, H.I., Cruzado-Oliva, F.H., Coronel-Zubiate, F.T., Meza-M\u00e1laga, J.M., Luj\u00e1n-Valencia, S.A., Luj\u00e1n-Urviola, E., Echevarria-Goche, A., Farje-Gallardo, C.A., Castillo-Cornock, T.B., and Serquen-Olano, K. (2024). Periodontal Disease and Cardiovascular Disease: Umbrella Review. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04907-1"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6080\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:43:46Z","timestamp":1785919426000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6080"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":23,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15156080"],"URL":"https:\/\/doi.org\/10.3390\/jcm15156080","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]}}}