Background Inadequate preventive dental care may contribute to inflammatory conditions such as periodontitis, increasing cardiovascular disease risk. Artificial intelligence–enabled electrocardiography (AI‐ECG) algorithms accurately estimate cardiovascular disease risk. We investigated the association between inadequate preventive dental care and the AI‐ECG–estimated risk of atrial fibrillation, aortic stenosis, low ejection fraction, cardiac amyloid, cardiovascular aging, and all‐cause mortality. Methods We retrospectively analyzed 266 637 Mayo Clinic patients (2018–2024) who completed a Social Determinants of Health Survey and had an ECG performed within 1 year of survey completion. AI‐ECG algorithms generated continuous risk scores (0 or 1) for atrial fibrillation, aortic stenosis, low ejection fraction, and amyloid. Cardiac aging was assessed by delta age, calculated as AI‐ECG–estimated physiological age minus the chronological age. Associations with preventive dental care were analyzed using logistic regression. Cox regression evaluated dental care predictiveness on all‐cause mortality. Results Among 266 637 individuals (mean age, 59.5±16.4 years; 51.1% women), 49 918 (18.7%) reported inadequate preventive dental care. These individuals had higher delta age and increased AI‐ECG–predicted risks of atrial fibrillation, aortic stenosis, amyloid, and reduced ejection fraction (all P <0.001). In multivariable logistic regression models including all AI‐ECG scores, inadequate preventive dental care was associated with higher probabilities of low ejection fraction (odds ratio OR, 1.80 95% CI, 1.69–1.91), atrial fibrillation (OR, 1.10 95% CI, 1.04–1.17), aortic stenosis (OR, 1.90 95% CI, 1.64–2.20), amyloid (OR, 1.18 95% CI, 1.12–1.25), and higher delta age (OR, 1.03 95% CI, 1.02–1.03) (all P <0.001). Inadequate preventive dental care predicted all‐cause mortality after adjusting for demographics, risk factors, and AI‐ECG algorithms (HR, 1.45 95% CI, 1.38–1.53, P <0.001). Conclusions Inadequate preventive dental care is associated with subclinical cardiovascular disease. AI‐ECG algorithms may facilitate cardiovascular risk stratification among individuals with limited preventive dental care access.
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