Risk of incident cardiovascular disease in people with periodontal disease: A systematic review and meta‐analysis

Abstract

Objectives Cardiovascular disease (CVD) is a major cause of mortality; periodontal disease (PD) affects up to 50% of the world's population. Observational evidence has demonstrated association between CVD and PD. Absent from the literature is a systematic review and meta‐analysis of longitudinal cohort studies quantifying CVD risk in PD populations compared to non‐PD populations. To examine the risk of incident CVD in people with PD in randomised controlled trials and longitudinal cohort studies. Material and Methods We searched Medline, EMBASE and Cochrane databases up to 9th Oct 2019 using keywords and MeSH headings using the following concepts: PD, CVD, longitudinal and RCT study design. CVD outcomes included but were not restricted to any CVD, myocardial infarction, coronary heart disease (CHD) and stroke. Diagnosis method and severity of PD were measured either clinically or by self‐report. Studies comparing incident CVD in PD and non‐PD populations were included. Meta‐analysis and meta‐regression was performed to determine risk of CVD in PD populations and examine the effects of PD diagnosis method, PD severity, gender and study region. Results Thirty‐two longitudinal cohort studies were included after full text screening; 30 were eligible for meta‐analysis. The risk of CVD was significantly higher in PD compared to non‐PD (relative risk [RR]: 1.20, 95% CI: 1.14–1.26). CVD risk did not differ between clinical or self‐reported PD diagnosis (RR = 0.97, 95% CI: 0.87–1.07,). CVD risk was higher in men (RR: 1.16, 95% CI: 1.08–1.25) and severe PD (RR: 1.25, 95% CI: 1.15–1.35). Among all types of CVD, the risk of stroke was highest (RR = 1.24; 95% CI:1.12–1.38), the risk of CHD was also increased (RR = 1.14; 95% CI:1.08–1.21). Conclusion This study demonstrated modest but consistently increased risk of CVD in PD populations. Higher CVD risk in men and people with severe PD suggests population‐targeted interventions could be beneficial.

Multimorbid disease trajectories for people with periodontitis

“…Among the same adult population, systemic diseases including cardiovascular disease (CVD), hypertension, diabetes, and inflammatory diseases are also highly prevalent (GBD 2019 Diseases and Injuries Collaborators, 2020). Robust evidence has shown that periodontitis is associated with increased risk of a number of systemic diseases (Borgnakke et al, 2013; Aguilera et al, 2019; Larvin et al, 2020a). This may be due to shared risk factors between conditions, alternatively periodontitis may be a risk factor for developing systemic diseases (Esteves‐Lima et al, 2020).…”

Recent Advances in the Impact of Infection and Inflammation on Stroke Risk and Outcomes

“…Recently, periodontal disease has emerged as a prototypical chronic infectious-inflammatory condition that may impact cerebrovascular health. Periodontitis is a chronic inflammatory disorder caused by polybacterial colonization and repeated low-grade exposure to gram-negative bacteria, leading to an increase in systemic inflammation [ 10 •]. A meta-analysis of 30 longitudinal cohort studies showed a modest but consistently increased risk of stroke by 1.24-fold in populations with periodontal disease [ 10 •].…”

“…Periodontitis is a chronic inflammatory disorder caused by polybacterial colonization and repeated low-grade exposure to gram-negative bacteria, leading to an increase in systemic inflammation [ 10 •]. A meta-analysis of 30 longitudinal cohort studies showed a modest but consistently increased risk of stroke by 1.24-fold in populations with periodontal disease [ 10 •]. In an Atherosclerosis Risk in Communities analysis, periodontal disease was associated particularly with cardioembolic and thrombotic stroke subtypes [ 11 ].…”

Oral Microbiota: A Major Player in the Diagnosis of Systemic Diseases

“…The first to raise the link between myocardial infarctions and poor oral health were Mattila et al in 1989 [77]. Since then, numerous studies have concluded a positive association between periodontal diseases and CVD independently of their common risk factors (smoking, age, diabetes) [75,[78][79][80][81]. Moreover, periodontal treatment has been shown to have beneficial effects on cardiovascular biochemical parameters such as endothelial function and C-Reactive Protein (CRP) levels [82][83][84][85].…”