Tooth loss and risk of incident cardiovascular events in an Iranian adult population: findings from Isfahan Cohort Study 2

Evidence on the association between tooth loss and incident cardiovascular disease (CVD) remains inconsistent, particularly in Low- and middle-income countries (LMICs). This study aimed to investigate the link between tooth loss and CVD risk and all-cause mortality in 1817 Iranian adults from the Isfahan Cohort Study 2 (2018–2023). The self-reported number of unreplaced missing teeth was examined. Acute myocardial infarction (AMI), ischemic heart disease (IHD), CVD, CVD mortality, and all-cause mortality were the outcome measures. After a median follow-up of 60.5 months (interquartile range: 52.8–66.9), the absolute numbers of AMI, IHD, CVD, CVD mortality, and all-cause mortality were 21, 79, 90, 4, and 10, respectively. In adjusted models, each additional unreplaced missing tooth was associated with a higher risk of AMI (HR 1.11; 95% CI 1.06–1.16; P < 0.001), IHD (HR 1.07; 95% CI 1.04–1.10; P < 0.001), and CVD (HR 1.06; 95% CI 1.04–1.09; P < 0.001). Associations with CVD mortality and all-cause mortality were not statistically significant. These findings suggest that tooth loss was associated with an increased risk of AMI, IHD, and CVD events but not with mortality outcomes. Therefore, tooth loss may serve as a simple clinical marker for identifying individuals at increased risk of CVD events.