Published Online
on July 15, 2004

A more recent version of this article appeared on September 1, 2004

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Submitted on February 12, 2004
Revised on April 16, 2004
Accepted on June 1, 2004

Gender Differences in the Relationship Between Periodontal Disease, Tooth Loss, and Atherosclerosis

Moïse Desvarieux MD, PhD; Christian Schwahn PhD; Henry Völzke MD; Ryan T. Demmer MPH; Jan Lüdemann PhD; Christof Kessler MD; David R. Jacobs Jr PhD; Ulrich John PhD; and Thomas Kocher DDS^*

From the Division of Epidemiology (M.D., R.T.D., D.R.J.), School of Public Health, and the Division of Infectious Disease and International Medicine, Department of Medicine, Medical School, University of Minnesota; the International Training and Research Program in Infectious Disease Epidemiology (INTREPIDE) Initiative in Global Heath (M.D.); the Abteilung Parodontologie (C.S., T.K.), Zentrum Zahn-, Mund und Kieferheilkunde, Institut für Epidemiologie und Sozialmedizin (H.V., U.J.), the Institut für Klinische Chemie (J.L.), and the Klinik für Neurologie (C.K.), University of Greifswald, Germany; and the Institute for Nutrition Research (D.R.J.), University of Oslo, Norway.

^* To whom correspondence should be addressed. E-mail: kocher{at}uni-greifswald.de.

Background and Purpose--Males carry a disproportionate burden of cardiovascular disease. Because males also bear a higher burden of periodontal disease, we investigated the existence of gender differences in the postulated relationship between periodontal infections, tooth loss, and subclinical atherosclerosis.

Methods--A total of 1710 randomly enrolled participants between the ages of 45 and 75 with no history of myocardial infarction or stroke received a clinical periodontal examination, carotid scan using high-resolution B-mode ultrasound, and extensive measurements for conventional cardiovascular risk factors (age, education, smoking, alcohol, body mass index, diabetes, systolic blood pressure, low-density lipoprotein-cholesterol, high-density lipoprotein-cholesterol, and triglycerides) as well as markers of healthy lifestyle and social network.

Results--In both genders, measures of current and long-term periodontitis worsened as tooth loss increased. In males but not females, an 10% difference in carotid artery plaque prevalence was observed between the lowest and highest tertiles of tooth loss (P<0.05) and long-term periodontitis (P=0.05) after multivariate adjustment. Similar patterns were observed for intima-media thickness. The influence of gender on carotid artery plaque prevalence was most evident among the younger age group (<59 years). Between genders, carotid plaque prevalence differed by 10%, 15%, and 25% across increasing levels of tooth loss, and by 5%, 15%, and 25% across increasing levels of long-term periodontitis.

Conclusions--Our data suggest that tooth loss and long-term periodontitis are related to subclinical atherosclerosis in men but not women. Gender variations in cardiovascular morbidity or mortality may be explained partly by the differential contributions of novel risk factors across genders.

Key words: atherosclerosis • gender • infection • periodontal disease • tooth loss

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