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Abstract：
Background To evaluate the association of dental diseases and oral hygiene care with incidence of heart failure (HF) among patients with type 2 diabetes. Methods and Results This study included 173 927 patients with type 2 diabetes aged ≥40 years, who underwent Korean National Health Insurance Service health examinations in 2008 and were followed up until the end of 2017. Hazard ratios (HRs) and 95% CIs for HF were estimated using multivariable Cox proportional hazards regression analysis. During a median follow-up of 9.3 years, 1.94% of participants developed HF. An increased number of missing teeth was associated with a higher risk of HF (P<0.001). HRs of HF increased among individuals with ≥15 missing teeth (HR, 1.37 [95% CI, 1.14-1.64]) compared with those without missing teeth. Decreased risk of HF was observed in individuals with ≥1 time/year of professional dental cleaning (HR, 0.93 [95% CI, 0.87-0.99]) and in those with ≥2 times/d of toothbrushing (HR, 0.90 [95% CI, 0.82-0.98]) compared with those without these practices. While combined presence of missing teeth and periodontal disease (P=0.004) or dental caries (P=0.007) increased HF risk, combined oral hygiene care was associated with further HF risk reduction (P=0.024). Better oral hygiene care was associated with decreased HF risk, even as the number of missing teeth increased (P<0.001). Conclusions Among patients with type 2 diabetes, dental diseases and oral hygiene care are important determinants of HF development. Dental disease management and good oral care may prevent HF in patients with type 2 diabetes.
摘要：
研究背景：评估2型糖尿病患者中牙科疾病和口腔卫生护理与心力衰竭(HF)发生率的关系。方法与结果本研究纳入173927例年龄≥40岁的2型糖尿病患者,他们在2008年接受了韩国国民健康保险服务的健康检查，并一直随访到2017年底。使用多变量Cox比例风险回归分析估计HF的危险比（HR）和95％CI。在9.3年的中位随访期间，1.94%的参与者发展为HF。缺失牙齿数量的增加与HF风险的增加相关(P<0.001)。在≥15颗牙齿缺失的个体中，HF的HR增加(HR，1.37[95%CI，1.14-1.64])与没有牙齿缺失的人相比。在专业牙齿清洁时间≥1次/年的个体中观察到HF风险降低（HR，0.93[95%CI，0.87-0.99])和刷牙≥2次/天的患者(HR，0.90[95%CI，0.82-0.98])与没有这些做法的人相比。虽然牙齿缺失和牙周病（P=0.004）或龋齿（P=0.007）的联合存在会增加HF风险，综合口腔卫生护理可进一步降低HF风险(P=0.024).更好的口腔卫生护理与降低HF风险相关，即使缺失牙齿的数量增加（P<0.001）。结论在2型糖尿病患者中,牙齿疾病和口腔卫生护理是HF发展的重要决定因素。牙科疾病管理和良好的口腔护理可以预防2型糖尿病患者的HF。
