The Association between Periodontal Disease and Cardiovascular Disease Risk: A Systematic Review

Abstract

Objectives: To ritically evaluate and synthesize the existing evidence on the association between periodontal disease (PD) and cardiovascular disease (CVD) risk. Methods: A total of 1332 pertinent publications were found after a comprehensive search across four databases. 67 full-text publications were examined after duplicates were eliminated using Rayyan QCRI and relevance was checked; twelve studies finally satisfied the requirements for inclusion. Results: We included twelve studies with a total of 1,288,208 participants, and 658,052 (51%) were males. The prevalence of CVD in patients with PD ranged from 1.9% of HF to 57.5% of ACVD. Studies on hypertension suggest that severe periodontitis correlates with an elevated risk, especially in younger individuals, and that even moderate gingivitis could independently contribute to high blood pressure. For atherosclerotic cardiovascular disease (ACVD), evidence is mixed, with some studies finding no significant impact, while others report a substantial increase in carotid plaques and arterial thickness associated with severe periodontitis. The risk of general CVD appears consistently elevated in individuals with advanced periodontitis, even after adjusting for confounders like smoking. Additionally, moderate to severe periodontitis is linked to a higher likelihood of heart failure. Conclusion: This review reinforces the evidence that PD is linked to a higher risk of cardiovascular conditions, including hypertension, ACVD, CVD, and heart failure. While PD may contribute to cardiovascular risk, further research is needed to confirm causation and understand mechanisms. Clinicians are encouraged to consider oral health's role in systemic health and incorporate periodontal care into cardiovascular risk management, potentially reducing cardiovascular risks and enhancing overall health outcomes.