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American Journal of Epidemiology Advance Access originally published online on July 31, 2009
American Journal of Epidemiology 2009 170(5):615-621; doi:10.1093/aje/kwp177
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

ORIGINAL CONTRIBUTIONS

Do Genetic Factors Explain the Association Between Poor Oral Health and Cardiovascular Disease? A Prospective Study Among Swedish Twins

Lorelei A. Mucci, Chung-cheng Hsieh, Paige L. Williams, Manish Arora, Hans-Olov Adami, Ulf de Faire, Chester W. Douglass and Nancy L. Pedersen

Correspondence to Dr. Lorelei A. Mucci, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, 9th Floor, Boston, MA 02115 (e-mail: lmucci{at}hsph.harvard.edu).

Received for publication November 17, 2008. Accepted for publication June 1, 2009.

Epidemiologic studies suggest positive associations between poor oral health and cardiovascular disease. The authors undertook a prospective study among 15,273 Swedish twins (1963–2000) to examine whether genetic factors underlying the 2 diseases could explain previous associations. They estimated hazard ratios and 95% confidence intervals controlling for individual factors and stratifying on twin pairs to control for familial effects. Quantitative genetic analyses estimated genetic correlations between oral diseases and cardiovascular disease outcomes. Tooth loss (hazard ratio (HR) = 1.2, 95% confidence interval (CI): 1.1, 1.4) and periodontal disease (HR = 1.3, 95% CI: 1.0, 1.4) were associated with small excess risks of cardiovascular disease; periodontal disease was also associated with coronary heart disease (HR = 1.4, 95% CI: 1.1, 1.6). Adjustment for genetic factors in co-twin analyses did not appreciably change estimates. In contrast, tooth loss was more strongly associated with coronary heart disease in twin models (HR = 2.1, 95% CI: 1.2, 3.8) compared with adjusting for individual factors alone (HR = 1.3, 95% CI: 1.1, 1.4). There was evidence of shared genetic factors between cardiovascular disease and tooth loss (rG = 0.18) and periodontal disease (rG = 0.29). Oral disease was associated with excess cardiovascular disease risk, independent of genetic factors. There appear to be common pathogenetic mechanisms between poor oral health and cardiovascular disease.

cardiovascular diseases; oral health; periodontal diseases; tooth loss; twin study

Abbreviations: h2, heritability; ICD-9, International Classification of Diseases, Ninth Revision; IL, interleukin


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