Risk Factors for CADFrequency of daily tooth brushing and subsequent cardiovascular eventsKobayashi, Daikia,,b,,c; Mizuno, Atsushid,,e; Mitsui, Rief; Shimbo, TakurogAuthor Information aDivision of General Internal Medicine, Department of Medicine, St. Luke’s International Hospital bDepartment of Epidemiology, St. Luke’s International University Graduate School of Public Health, Tokyo cDepartment of medicine, Fujita Medical University, Toyoake, Japan dDepartment of Cardiology, Juntendo University Hospital eDepartment of Cardiology, St. Luke’s International Hospital fDepartment of medicine, The Center for Preventive Medicine, St. Luke’s International Hospital, Tokyo gDepartment of Medicine, Ohta Nishinouchi Hospital, Koriyama, Japan Received 17 September 2019 Accepted 19 February 2020 Correspondence to Daiki Kobayashi, MD, MPH, MBA, PhD, Division of General Internal Medicine, Department of Medicine, St. Luke’s International Hospital, 1048560 Tokyo, Japan, Tel/fax: +81 3 3541 5151; e-mail: firstname.lastname@example.org Coronary Artery Disease: September 2020 - Volume 31 - Issue 6 - p 545-549 doi: 10.1097/MCA.0000000000000882 Buy Metrics Abstract Objective Although previous studies have shown an inverse association between the frequency of daily tooth brushing and cardiovascular risk factors, research on cardiovascular events is limited. This study aimed to evaluate the association between the frequency of daily tooth brushing and subsequent cardiovascular events. Methods and results A retrospective longitudinal study was conducted at a hospital in Tokyo, Japan. We included all participants who underwent health check-ups from 2005 to 2011 and followed up to 2018. Our outcomes were the development of cardiovascular events. Outcomes were compared by the frequency of daily tooth brushing with a generalized estimating equation, adjusting for potential confounders. A total of 71 221 participants were included. The mean age was 45.6 years and 50.3% were male. During a median follow-up of 2061 (interquartile range: 933–3311) days, 1905 participants developed cardiovascular events. The adjusted odds ratios (ORs) of cardiovascular events increased in a dose-dependent manner as the frequency of tooth brushing decreased. Even those who brushed their teeth once in a day had a higher adjusted OR of stroke (1.22; 95% confidence interval, 1.01–1.48) than did those who brushed after every meal. Conclusions Frequent tooth brushing was inversely associated with subsequent cardiovascular events in a dose-dependent manner. Even brushing one’s teeth once a day may be related to an increased likelihood of stroke than brushing one’s teeth after every meal. Less frequent tooth brushing may be considered to be a marker for subsequent cardiovascular disease and coronary heart disease, rather than a risk factor. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.