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Poor Oral Health Predicts Higher 10-Year Cardiovascular Risk

A Propensity Score Matching Analysis

Hwang, Seon Young, PhD, RN; Shim, Jae Lan, PhD, RN; Kang, Dayun, MS; Choi, Jungsoon, PhD

doi: 10.1097/JCN.0000000000000497
ARTICLES: Risk Factors

Background: Although the association between periodontitis and cardiovascular disease (CVD) has been reported, whether periodontitis and poor oral health behavior influence CVD risk remains unclear.

Objective: The aim of this study was to examine whether periodontal disease and poor oral health behavior predict 10-year general CVD risk using the Framingham Risk Score.

Methods: Patients older than 30 years with no CVD history (n = 8370) were selected using cross-sectional study data from the Korean National Health and Nutrition Examination Survey in 2013 and 2014. To reduce selection bias in this population-based study, propensity score matching analysis was used with SPSS and R programs to compare CVD risk.

Results: Overall, 39.2% of the study population (n = 3277) had a global CVD risk of 10% or greater. In the low- and at-risk groups, 20.7% and 45.3% of patients, respectively, were diagnosed with periodontal disease by a dentist. Moreover, 43.2% and 62.8% of the low- and at-risk group patients, respectively, brushed teeth less than 3 times a day. After 1:1 propensity score matching of the low-risk (n = 1135) and at-risk (n = 1135) groups, bivariate analyses showed that a diagnosis of periodontal disease and less frequent toothbrushing were associated with a higher CVD risk (P < .001). Logistic regression analysis also showed that patients having periodontal disease and who brushed teeth less frequently were 1.38 and 1.33 times, respectively, more likely to be at risk of CVD (P < .001).

Conclusion: Education on periodontitis management and oral hygiene behavior should be included, when strategies for public risk reduction of CVD are developed.

Seon Young Hwang, PhD, RN Professor, School of Nursing, Hanyang University, Seoul, South Korea.

Jae Lan Shim, PhD, RN Assistant Professor, Department of Nursing, College of Medicine, Dongguk University, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea.

Dayun Kang, MS PhD Student, Department of Applied Statistics, College of Natural Sciences, Hanyang University, Seoul, South Korea.

Jungsoon Choi, PhD Assistant Professor, Department of Mathematics, College of Natural Sciences, Hanyang University, Seoul, South Korea.

This study was funded by Hanyang University Research Funds in 2017.

The authors have no conflicts of interest to disclose.

Correspondence Jae Lan Shim, PhD, RN, Department of Nursing, College of Medicine, Dongguk University, 123 Dongdae-ro, Gyeongju-si, Gyeongsangbuk-do, Republic of Korea (

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