Losing two or more natural teeth in middle age may signal an increased risk for coronary heart disease, a U.S. study suggests.

“In addition to other established associations between dental health and risk of disease, our findings suggest that middle-aged adults who have lost two or more teeth in recent past could be at increased risk for cardiovascular disease,” Dr. Lu Qi of Tulane University in New Orleans said in a statement.

Qi presented the study findings at the American Heart Association’s Epidemiology and Prevention, Lifestyle and Cardiometabolic Health Scientific Sessions.

The study team analyzed data on women and men from the long-term Nurses’ Health Study (NHS) and Health Professionals Follow-Up Study (HPFS).

The participants were between 45 and 69 years old at the outset and did not have heart disease. They were asked about the number of natural teeth first in 1986 in the HPFS, and in 1992 in the NHS.

On follow-up questionnaires, participants reported whether they had any recent tooth loss. Among adults with 25 to 32 natural teeth at the beginning of the study, those who lost two or more teeth during follow-up had a 23 percent increased risk of coronary heart disease compared with those who didn’t lose any teeth.

This was true after adjusting for diet quality, physical activity, body weight, hypertension, and other cardiovascular risk factors.