Abstract A009: Regular Dental Care and Reduced Risk of Secondary Ischemic Stroke in Patients with Cardiovascular Disease

Background: Oral health has been linked to incident cardiovascular disease outcomes including stroke, but its role in secondary stroke prevention is not well established. We investigated whether regular dental care utilization is associated with reduced risk of secondary ischemic stroke in subjects with a history of cardiovascular events including stroke or myocardial infarction. Methods: We analyzed Atherosclerosis Risk in Communities (ARIC) Study data to examine associations between oral health behaviors and secondary ischemic stroke in subjects with a history of cardiovascular events that were followed for up to 25 years. Oral health behaviors, assessed by questionnaire at Visit 4, included: regular dental visits (≥1/year vs. episodic/none), brushing (>1/day vs. ≤1/day), and flossing (≥1/week vs. <1/week). Subjects were categorized into regular or episodic dental care utilization groups. Kaplan–Meier survival analysis compared stroke-free survival between these groups. Univariate and multivariable Cox regression models estimated crude and adjusted Hazards ratios (HRs) for secondary ischemic stroke, adjusting for demographics (age, sex, and race), vascular risk factors (hypertension, diabetes, smoking status), oral hygiene practices (brushing, flossing), and medication use (aspirin, statin, and oral anticoagulants). Results: The sample included 1,224 subjects (mean age 64.6 ± 5.5 years; 66% male; 81% White, 19% Black). Regular flossing was reported by 43%, brushing by 55%, and dental visits by 52%. Of 637 regular dental care users and 587 episodic users, the regular users demonstrated significantly higher stroke-free survival (log-rank p < 0.001; Figure 1). In Cox regression models, regular dental care use was associated with reduced risk of secondary ischemic stroke (Crude HR = 0.56, 95% CI 0.40–0.78, p <0.001). The association remained significant after adjustment for demographics, vascular risk, oral hygiene practices, and medication use (Adjusted HR = 0.61, 95% CI 0.40–0.93, p = 0.02). Conclusions: Regular dental care utilization was associated with a 39% lower risk of secondary ischemic stroke among patients with cardiovascular disease, independent of demographics, vascular risk factors, oral hygiene behaviors, and medication use. These findings highlight oral health care as an actionable and underrecognized component of secondary stroke prevention, suggesting that promoting regular dental visits may improve long-term cerebrovascular outcomes.