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Association between periodontitis and ischemic stroke: a systematic review and meta-analysis

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Abstract

Several observational studies have suggested an association between periodontitis and cerebral ischemia. This meta-analysis aimed to investigate whether this link exists, and if so, the degree to which it is significant. The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline for systematic review was used. The search strategy included using electronic databases and hand searching works published up to March 2015. MEDLINE via PubMed, EMBASE, Proceedings Web of Science and Current Contents Connect were searched by two independent reviewers. Case-control, cross-sectional or cohort studies including patients with measures of periodontitis and ischemic stroke were eligible to be included in the analysis. Quality assessments of selected studies were performed. From a total of 414 titles and abstracts, 57 potentially relevant full text papers were identified. After inclusion criteria were applied, 8 studies were included in the present systematic review (5 case-control and 3 cohort studies). Although it was not the intention, cross-sectional studies were excluded due to eligibility criteria were not accomplished. Therefore, meta-analyses were conducted with data retrieved from the 8 studies included. These meta-analyses showed statistically significant association between periodontitis and ischemic stroke in both cohort pooled relative risks at 2.52 (1.77–3.58), and case-control studies pooled relative risks at 3.04 (1.10–8.43). In conclusion, the present meta-analysis demonstrated an association between periodontitis and ischemic stroke. However, well-designed prospective studies should be carried out to provide robust evidence of the link between both diseases. In regards to ischemic stroke subtypes, further case-control studies should be carried out to investigate whether there is any association between the different subtypes of cerebral infarcts and periodontitis.

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Acknowledgments

Y. Leira is recipient of a fellowship from Health Research Institute of Santiago de Compostela (IDIS). Furthermore, we thank Dr. Zhiying You (Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, United States) for providing additional information about his study.

Funding

This study has been partially supported by grants from Instituto de Salud Carlos III (PI13/02027), Spanish Research Network on Cerebrovascular Diseases RETICS-INVICTUS (RD12/0014), Xunta de Galicia (Consellería Educación GRC2014/027) and the European Union program FEDER. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author contribution statement

To qualify for authorship, we indicate the contribution of each author to this manuscript: Leira, Y: conception and design, acquisition of data, analysis and interpretation of data, drafting the article, revising it critically for important intellectual content and final approval of the version to be published. Seoane, J: conception and design, acquisition of data, analysis and interpretation of data, revising the article critically for important intellectual content and final approval of the version to be published. Blanco, M; Rodríguez-Yáñez, M: revising the article critically for important intellectual content and final approval of the version to be published. Takkouche, B: analysis and interpretation of data, revising the article critically for important intellectual content and final approval of the version to be published. Blanco, J; Castillo, J: conception and design, revising the article critically for important intellectual content and final approval of the version to be published.

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Authors and Affiliations

  1. Department of Periodontology, Faculty of Medicine, School of Dentistry, University of Santiago de Compostela, Rúa Entrerríos, S/N, 15782, Santiago de Compostela, A Coruña, Spain

    Yago Leira, Juan Seoane & Juan Blanco

  2. Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain

    Yago Leira

  3. Clinical Neurosciences Research Laboratory, Department of Neurology, Neurovascular Area, Health Research Institute of Santiago de Compostela (IDIS), Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain

    Miguel Blanco, Manuel Rodríguez-Yáñez & José Castillo

  4. Department of Preventive Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain

    Bahi Takkouche

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  1. Yago Leira
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Correspondence to Yago Leira.

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Leira, Y., Seoane, J., Blanco, M. et al. Association between periodontitis and ischemic stroke: a systematic review and meta-analysis. Eur J Epidemiol 32, 43–53 (2017). https://doi.org/10.1007/s10654-016-0170-6

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  • DOI: https://doi.org/10.1007/s10654-016-0170-6

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