Periodontal Disease and Coronary Heart Disease Incidence: A Systematic Review and Meta-analysis
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Periodontal disease is common among adults in the US and is a potential source of chronic inflammation. Recent data have suggested an important role for chronic inflammation in the development of coronary heart disease (CHD).
To aid the United States Preventive Services Task Force (USPSTF) in evaluating whether periodontal disease is an independent novel risk factor for incident CHD.
Studies were identified by searching Medline (1966 through March 2008) and reviewing prior systematic reviews, reference lists, and consulting experts. Prospective cohort studies that assessed periodontal disease, Framingham risk factors, and coronary heart disease incidence in the general adult population without known CHD were reviewed and quality rated using criteria developed by the USPSTF. Meta-analysis of good and fair quality studies was conducted to determine summary estimates of the risk of CHD events associated with various categories of periodontal disease.
We identified seven articles of good or fair quality from seven cohorts. Several studies found periodontal disease to be independently associated with increased risk of CHD. Summary relative risk estimates for different categories of periodontal disease (including periodontitis, tooth loss, gingivitis, and bone loss) ranged from 1.24 (95% CI 1.01–1.51) to 1.34 (95% CI 1.10–1.63). Risk estimates were similar in subgroup analyses by gender, outcome, study quality, and method of periodontal disease assessment.
Periodontal disease is a risk factor or marker for CHD that is independent of traditional CHD risk factors, including socioeconomic status. Further research in this important area of public health is warranted.
- Kochanek KD, Murphy SL, et al. Final Data for 2002. National Statics Reports. Vol 53. Hyattsville, Maryland: National Center for Health Statistics; 2004.
- Mackay J, Mensah GA. The Atlas of Heart Disease and Stroke. Geneva: WHP; 2004.
- Anonymous. Heart Disease and Stroke Statistics. American Heart Association; 2006.
- Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Eng J Med. 2000;342(12):836–43. CrossRef
- Brown LJ, Brunelle JA, Kingman A. Periodontal status in the United States. J Dent Res. 1996;75:672–83. In 5/5/2005.
- Douglass CW, Jette AM, Fox CH, et al. Oral health status of the elderly in New England. J Gerontol. 1993;48:M39–46. In 65/6/05.
- Papapanou PN. Periodontal diseases: epidemiology. Annals of Periodontology. 1996;1:1–36. In 5/5/2005.
- D’Aiuto F, Parkar M, Andreou G, Brett PM, Ready D, Tonetti MS. Periodontitis and atherogenesis: causal association or simple coincidence? J Clin Periodontol. 2004;31(5):402–11. CrossRef
- Ebersole JL, Machen RL, Steffen MJ, Willmann DE. Systemic acute-phase reactants, C-reactive protein and haptoglobin, in adult periodontitis. Clin Exp Immunol. 1997;107(2):347–52, Feb. CrossRef
- Kweider M, Lowe GD, Murray GD, Kinane DF, McGowan DA. Dental disease, fibrinogen and white cell count; links with myocardial infarction. Scott Med J. 1993;38:73–4. In 5/6/05.
- Noack B, Genco RJ, Trevisan M, Grossi S, Zambon JJ, De Nardin E. Periodontal infections contribute to elevated systemic C-reactive protein level. J Periodontol. 2001;72(9):1221–7, Sep. CrossRef
- Slade GD, Offenbacher S, Beck JD, Heiss G, Pankow JS. Acute-phase inflammatory response to periodontal disease in the US population. J Dent Res. 2000;79(1):49–57, Jan.
- Wu T, Trevisan M, Genco R, et al. Examination of the relation between periodontal health status and cardiovascular risk factors: serum total and high-density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen. Am J Epidemiol. 2000;151:273–82. In 5/6/05.
- Janket SJ, Baird AE, Chuang SK, Jones JA. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endo. 2003;95(5):559–69. CrossRef
- Khader YS, Albashaireh ZS, Alomari MA. Periodontal diseases and the risk of coronary heart and cerebrovascular diseases: a meta-analysis. J Periodontol. 2004;75(8):1046–53. CrossRef
- Harris RP, Helfand M, Woolf SH, et al. Current methods of the US Preventive Services Task Force. A review of the process. Am J Prev Med. 2001;30(3S):21–35. CrossRef
- Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34, Sep 13.
- Ajwani S, Mattila KJ, Tilvis RS, Ainamo A. Periodontal disease and mortality in an aged population. Spec Care Dent. 2003;23(4):125–30. CrossRef
- Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol. 1996;67(10 Suppl):1123–37.
- DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM. Dental disease and risk of coronary heart disease and mortality. BMJ. 1993;306(6879):688–91. CrossRef
- Howell TH, Ridker PM, Ajani UA, Hennekens CH, Christen WG. Periodontal disease and risk of subsequent cardiovascular disease in U.S. male physicians. J Am Coll Cardiol. 2001;37(2):445–50. CrossRef
- Hung HC, Joshipura KJ, Colditz G, et al. The association between tooth loss and coronary heart disease in men and women. J Public Health Dent. 2004;64(4):209–15.
- Morrison HI, Ellison LF, Taylor GW. Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases. J Cardiovasc Risk. 1999;6(1):7–11.
- Tuominen R, Reunanen A, Paunio M, Paunio I, Aromaa A. Oral health indicators poorly predict coronary heart disease deaths. J Dent Res. 2003;82(9):713–8.
- Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontal disease and coronary heart disease risk. JAMA. 2000;284(11):1406–10. CrossRef
- Mattila KJ, Nieminen M, Valtonen V, et al. Association between dental health and acute myocardial infarction. Br Med J. 1989;298:779–81. In 5/6/05.
- Mattila KJ, Valtonen V, Nieminen M, Huttunen JK. Dental infection and the risk of new coronary events: prospective study of patients with coronary artery disease. Clin Infect Dis. 1995;20:588–92. In 5/6/05.
- Persson RG, Ohlsson O, Pettersson T, Renvert S. Chronic periodontitis, a significant relationship with acute myocardial infarction. Eur Heart J. 2003;24(23):2108–15. CrossRef
- Mattila KJ, Rasi V, Nieminen M, et al. von Willebrand factor antigen and dental infections. Thomb Res. 1989;56:325–9. In 5/6/05. CrossRef
- Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499–511, Jan 28. CrossRef
- Deliargyris EN, Marron I, Kadoma W, et al. Periodontal disease and acute myocardial infarction. Circulation. 2000;460(Suppl. II):II–710 (Abstr. 3436), In 5/6/05.
- Arbes SJ, Slade GD, Beck J. Association between extent of periodontal attachment loss and self-reported history of heart attack: an analysis of NHANES III data. J Dent Res. 1999;78:1777–82. In 5/6/05.
- Buhlin K, Gustaffson A, Hakansson J, et al. Oral health and cardiovascular disease in Sweden. J Clin Periodontol. 2002;29:254–9. In 5/6/05. CrossRef
- Loesche WJ, Shork A, Terpenning MS, Chen Y-M, Dominguez BL, Grossman N. Assessing the relationship between dental disease and coronary heart disease in elderly US veterans. J Am Dent Assoc. 1998;129:301–11. In 5/6/05.
- Mattila KJ, Valle MS, Nieminen M, Valtonen V, Hietaniemi KL. Dental infections and coronary atherosclerosis. Atherosclerosis. 1993;103:205–11. In 5/6/05. CrossRef
- Glurich I, Grossi S, Albini B, et al. Systemic inflammation in cardiovascular and periodontal disease: comparative study. Clin Diagn Lab Immunol. 2002;9(2):425–32, Mar. CrossRef
- Joshipura KJ, Wand HC, Merchant AT, Rimm EB. Periodontal disease and biomarkers related to cardiovascular disease. J Dent Res. 2004;83(2):151–5.
- Sahingur SE, Sharma A, Genco RJ, De Nardin E. Association of increased levels of fibrinogen and the -455G/A fibrinogen gene polymorphism with chronic periodontitis. J Periodontol. 2003;74(3):329–37, Mar. CrossRef
- D’Aiuto F, Ready D, Tonetti MS. Periodontal disease and C-reactive protein-associated cardiovascular risk. J Periodontal Res. 2004;39(4):236–41. CrossRef
- Tonetti MS, D’Aiuto F, Nibali L, et al. Treatment of periodontitis and endothelial function. N Eng J Med. 2007;356(9):911–20, Mar 1. CrossRef
- Haraszthy VI, Zambon JJ, Trevisan M, Zeid M, Genco RJ. Identification of periodontal pathogens in atheromatous plaques. J Periodontol. 2000;71(10):1554–60, Oct. CrossRef
- Beck JD, Elter JR, Heiss G, Couper D, Mauriello SM, Offenbacher S. Relationship of periodontal disease to carotid artery intima-media wall thickness: the Atherosclerosis Risk in Communities (ARIC) study. Arterioscler Thromb Vasc Biol. 2001;21(11):1816–22. CrossRef
- Desvarieux M, Demmer RT, Rundek T, et al. Relationship between periodontal disease, tooth loss, and carotid artery plaque: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Stroke. 2003;34(9):2120–5. CrossRef
- Nakib SA, Pankow JS, Beck JD, et al. Periodontitis and coronary artery calcification: the Atherosclerosis Risk in Communities (ARIC) study. J Periodontol. 2004;75(4):505–10. CrossRef
- Sharma A, Novak EK, Sojar HT, Swank RT, Kuramitsu HK, Genco RJ. Porphyromonas gingivalis platelet aggregation activity: outer membrane vesicles are potent activators of murine platelets. Oral Microbiol Immunol. 2000;15(6):393–6, Dec. CrossRef
- Genco R, Offenbacher S, Beck J. Periodontal disease and cardiovascular disease: epidemiology and possible mechanisms. J Am Dent Assoc. 2002;133.
- Grau AJ, Buggle F, Ziegler C, et al. Association between acute cerebrovascular ischemia and chronic and recurrent infection. Stroke. 1997;28:1724–9. In 5/6/05.
- Syrjanen J, Peltola J, Valtonen V, et al. Dental infections in association with cerebral infarction in young and middle-ages men. J Intern Med. 1989;225:179–84. In 5/6/05.
- Desvarieux M, Demmer RT, Rundek T, et al. Periodontal microbiota and carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Circulation. 2005;111(5):576–82, Update Search 3/15/06. CrossRef
- Soder PO, Soder B, Nowak J, et al. Early carotid atherosclerosis in subjects with periodontal diseases. Stroke. 2005;36(6):1195–200, Update Search 3/15/06. CrossRef
- Wu T, Trevisan M, Genco RJ, Dorn JP, Falkner KL, Sempos CT. Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study. Arch Intern Med. 2000;160(18):2749–55. CrossRef
- Mendez MV, Scott T, LaMorte W, Vokonas P, Menzoian JO, Garcia R. An association between periodontal disease and peripheral vascular disease. Am J Surg. 1998;176(2):153–7. CrossRef
- Jansson L, Lavstedt S, Frithiof L. Relationship between oral health and mortality rate. J Clin Periodontol. 2002;29(11):1029–34. CrossRef
- Gonzalez YM, De Nardin A, Grossi SG, Machtei EE, Genco RJ, De Nardin E. Serum cotinine levels, smoking, and periodontal attachment loss. J Dent Res. 1996;75(2):796–802, Feb.
- Nishida M, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ. Dietary vitamin C and the risk for periodontal disease. J Periodontol. 2000;71(8):1215–23, Aug. CrossRef
- Nishida M, Grossi SG, Dunford RG, Ho AW, Trevisan M, Genco RJ. Calcium and the risk for periodontal disease. J Periodontol. 2000;71(7):1057–66, Jul. CrossRef
- Becker A, Leber A, Becker C, Knez A. Predictive value of coronary calcifications for future cardiac events in asymptomatic individuals. Am Heart J. 2008;155(1):154–60, Jan. CrossRef
- Couper DJ, Beck JD, Falkner KL, et al. The Periodontitis and Vascular Events (PAVE) pilot study: recruitment, retention, and community care controls. J Periodontol. 2008;79(1):80–9, Jan. CrossRef
- Periodontal Disease and Coronary Heart Disease Incidence: A Systematic Review and Meta-analysis
Journal of General Internal Medicine
Volume 23, Issue 12 , pp 2079-2086
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Oregon Evidence-based Practice Center, Veterans Affairs Medical Center, Portland, OR, USA
- 2. Department of Medical Informatics and Clinical Epidemiology, Veterans Affairs Medical Center, Portland, OR, USA
- 3. Department of Medicine, Veterans Affairs Medical Center, Portland, OR, USA
- 4. Public Health and Preventive Medicine, Veterans Affairs Medical Center, Portland, OR, USA
- 7. Oregon Health & Science University, Hospital and Specialty Medicine, Veterans Affairs Medical Center, Portland, OR, USA
- 8. Oregon Health & Science University, Portland, OR, USA
- 5. Emergency Medicine, Veterans Affairs Medical Center, Portland, OR, USA
- 6. Family Medicine, Veterans Affairs Medical Center, Portland, OR, USA