Abstract
ObjectivesCardiovascular 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 MethodsWe 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.ResultsThirty‐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).ConclusionThis 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.
Highlights
Cardiovascular diseases (CVD) are among the leading causes of mortality generating severe burden on global healthcare (Mahase, 2019); while periodontal disease (PD) affects about 20–50% of the global population and PD prevalence has remained consistently high over the past two decades (Kassebaum et al, 2014)
Random effects meta-analysis demonstrates that there is a significant increase in risk of all incident CVD in PD population compared to non-PD population (RR = 1.20, 95% confidence intervals (CI): 1.14–1.26; Figure 2)
Subgroup meta-analysis revealed that the risk of all incident CVD in studies utilising clinical PD diagnosis was 22% higher in PD (RR = 1.22, 95% CI: 1.14–1.30) and in self-reported diagnosis was 17% higher in PD (RR = 1.17, 95% CI: 1.09–1.25) compared with nonPD (Figure 2), and there was no significant difference in diagnosis method using meta-regression (RR = 0.97, 95% CI: 0.87–1.07, Table 2)
Summary
Cardiovascular diseases (CVD) are among the leading causes of mortality generating severe burden on global healthcare (Mahase, 2019); while periodontal disease (PD) affects about 20–50% of the global population and PD prevalence has remained consistently high over the past two decades (Kassebaum et al, 2014). Observational studies have shown an association between periodontal disease (PD) and cardiovascular diseases (CVD). Causal links between PD and CVD have previously been postulated. These investigations often implicate PD-associated bacteria including Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans and their associated pathogens and inflammatory pathways as the cause (Bale, Doneen, & Vigerust, 2017; de Boer et al, 2014; Gao et al, 2016; Liao et al, 2009; Mougeot et al, 2017; Sayehmiri et al, 2015). Pathogenic and systemic effects of bacteraemia have been observed in patients after oral procedures (Baltch et al, 1988), advocating an additional possible causal association. While there is still much to be learnt regarding the actual mechanism between PD and subsequent CVD, the data linkage of electronic dental, medical and insurance records permits non-intrusive observational research into associations between CVD and PD (Mark Bartold & Mariotti, 2017)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
