Strong Heart, Strong Smile: Tooth Loss and Incidence of CVD in American Indian Populations

Tooth loss and cardiovascular disease (CVD) share risk factors and complex pathways in disease progression and co-morbidities. To date, little research on the relationship between tooth loss and CVD has been conducted in American Indian populations. This study investigated the prevalence of edentulism among American Indian adults and its association with the incidence of CVD.

The ongoing longitudinal Strong Heart Study (SHS) is being conducted in rural American Indian communities in North Dakota, South Dakota and Oklahoma since 1989. This cohort study included SHS participants who had available tooth loss data during the 1997-1999 wave, which serves as the baseline for this analysis. Data analysis was performed in August 2023. Anthropometric, health and behaviour data were obtained from physical exams and interviews. Participants who reported no natural teeth were considered edentulous. CVD events were obtained from continuous mortality and morbidity surveillance through 2019. Crude and adjusted Cox proportional hazards regression models were fit to examine the association of edentulism with CVD events.

Of 1982 participants, 29% (n = 584) were edentulous at baseline, and 41% (n = 822) developed CVD during up to 22 years follow-up. When adjusting for site, age, sex, education, smoking, diabetes, BMI and hypertension, the hazard ratio for developing CVD was 1.36 (95% CI: 1.15, 1.60) for the participants who were edentulous when compared to those reporting natural teeth present.

The findings confirm the high burden of oral diseases and CVD among this sample of American Indians and suggest a significant positive association between edentulism and incidence of CVD that was partially explained by shared risk factors. The study highlights the need for interventions that address risk factors for non-communicable diseases to improve both oral health and cardiovascular health of American Indians.