The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease

Abstract

The epidemiological evidence behind the association between periodontitis and incident atherosclerotic cardiovascular disease. J Clin Periodontol 2013; 40 (Suppl. 14): S70-S84. doi: 10.1111/jcpe.12062. AbstractObjectives: The objective of this study was to systematically review the epidemiological evidence for an association between periodontitis (PD) and incident atherosclerotic cardiovascular disease (ACVD), including coronary heart disease (CHD), cerebrovascular disease and peripheral arterial disease. Methods: Systematic review of cohort and case-control studies on the association of clinically or radiographically diagnosed PD and ACVD. Results: Overall, 12 studies were included in this study (six studies on CHD, three studies on cerebrovascular disease, two studies on both coronary heart and cerebrovascular disease mortality and one study on peripheral arterial disease). All but one study reported positive associations between various periodontal disease measures and the incidence of ACVD, at least in specific subgroups. The association was stronger in younger adults and there was no evidence for an association between PD and incident CHD in subjects older than 65 years. Only one study evaluated the association between PD and secondary cardiovascular events. Conclusions: There is evidence for an increased risk of ACVD in patients with PD compared to patients without. However, this may not apply to all groups of the population. There is insufficient evidence for an association between PD and the incidence of secondary cardiovascular events. The possible association between periodontitis (PD) and atherosclerotic cardiovascular disease (ACVD) has received much attention over the past two decades, and a significant number of epidemiological studies have been conducted during this time. The evidence has been systematically reviewed several times during that period (Hujoel 2002, Janket et al. 2003, Khader et al. 2004, Bahekar et al. 2007, Humphrey et al. 2008, Blaizot et al. 2009). Most recently, a comprehensive review was performed by an American Heart Association (AHA) working group (Lockhart et al. 2012), which concluded that "periodontal disease is associated with atherosclerotic vascular disease independent of known confounders". It further concluded that there was no evidence for a causal link and that, therefore, "statements that imply a causative association between periodontal disease and specific atherosclerotic vascular disease events […] are unwarranted". The review further highlighted several research gaps and methodological issues relevant to further research, including the need for uniform criteria for PD measures and case definitions but mainly with regard to the need of well-designed controlled interventional studies with standard treatment protocols and considerations for issues such as the sustainability of treatment response over time.The aim of this review was to systematically review the evidence for the association between PD and incident ACVD, focusing on the most robust studies in terms ...

The influence of prevalent cohort bias in the association between periodontal disease progression and incident coronary heart disease

“…The strength of the relative associations that we observed in the overall periodontitis cohort were similar to those observed by others who have evaluated prevalent periodontitis with respect to CHD outcomes [2,24,29], including within the DLS subject population [5]. The inclusion of subjects with prevalent periodontitis, however, appears to have resulted in lower estimates than those seen for persons with incident periodontitis.…”

“…Studies of the association between periodontitis and CHD outcomes have been conducted previously [2]. However, this study is the first to examine periodontitis progression as a predictor and to study it among a population of individuals suffering from periodontitis.…”

“…In the last 20 years, there has been a heightened interest in the relationship between periodontitis and cardiovascular conditions [2]. Proposed causal mechanisms include a direct effect of periodontal infection through bacteremia and an indirect effect of the inflammation that accompanies periodontitis (e.g., resultant increases in C-reactive protein) [3].…”

Role of Cytokines and Transcription Factors in Periodontitis: A Review of Cellular and Molecular Mechanisms

“…In individuals susceptible to periodontitis, absence of resolution of periodontal inflammation results in chronic inflammation, which may have a systemic impact (D'Aiuto et al, 2013;Dietrich et al, 2013;Ide and Papapanou, 2013;Linden and Herzberg, 2013;Taylor et al, 2013). The acute inflammatory response is protective, but failure to remove the inflammatory cells, especially neutrophils, promotes chronic, pathological and destructive lesions.…”

Periodontal Diseases and Possible Future Cardiovascular Events, Are they Related? An Overview

“…In the Saffi et al study, periodontal therapy decreased CRP and other proinflammatory biomarkers in CAD patients (42). Diabetes and smoking are considered to be common risk factors of cardiovascular and periodontal diseases (5,43). Therefore, the association between periodontal disease and cardiovascular outcomes has been examined in previous studies in nonsmokers and nondiabetic patients (44).…”