Is the Association between Periodontitis and Cardiovascular Diseases Causal?

Background 

Periodontitis (PD) and cardiovascular diseases (CVDs) are regarded as chronic inflammatory disorders and are among the most prevalent non-communicable diseases in the world. Observational studies have demonstrated a consistent relationship between PD and CVDs. Indeed, patients with PD have a moderately higher risk of CVDs, including stroke and myocardial infarction (MI). Several possible mechanisms, which include bacterial dissemination, systemic inflammation and microbiome changes, have been proposed. This review aims to appraise the existing evidence on the potential benefits of improving periodontal health in terms of future cardiovascular risk. 

Method 

This is a narrative review on the relationship between PD and CVDs. A literature review of randomized clinical trials and observational studies in the English language was done by one investigator (EHK) using MEDLINE OVID and Cochrane Oral Health Group’s Trial Register database up to March 2018. It was limited to the terms ‘cardiovascular diseases,’ ‘myocardial infarction,’ ‘coronary heart disease,’ ‘periodontal,’ ‘periodontitis,’ ‘treatment,’ ‘clinical trial,’ ‘systematic review’ and ‘meta-analysis.’ The search identified 24 articles in the Cochrane database and 84 articles in MEDLINE. References cited in the reviewed studies were assessed and included in the study if relevant. 

Results 

The search reaffirmed a relationship between the two diseases, with an average 15% higher risk of CVD in patients with PD. Nevertheless, no evidence was found to suggest that improved periodontal health affects CVD hard outcomes, such as stroke or MI. On the other hand, improving periodontal health ameliorates subclinical atherosclerosis, endothelial function and biomarkers of systemic inflammation.