Possible link between periodontal disease and coronary heart disease

Medline, Cochrane Library, Embase, Cinahl and the reference lists of published articles were used to identify relevant studies.

Studies were included if the sample sizes were >80 cases, cases were defined as people with fatal or nonfatal coronary artery disease (CAD); described either self-reported periodontal disease (PD) or that diagnosed by clinical assessment of oral health; and provided relative risks (RR) and odds ratios (OR,) or sufficient information for the calculation of RR or OR. Letters, unpublished articles, animal studies, duplicate reports and those providing association between different markers of CAD or particular pathogens involved in PD were excluded.

Data was extracted by two investigators using a standard protocol. Cohort studies, case-control studies and cross-sectional studies were analysed separately using the Comprehensive Meta-Analysis software package (version CM 2.2; Biostat, Englewood, New Jersey, USA). Heterogeneity of the studies was assessed using the Cochrane Q test. As the studies were homogeneous the Mantel-Haenszel fixed-effect model was used to compute common RR and OR.

Meta-analysis of the five prospective cohort studies (86 092 patients) found people with PD had a 1.14-fold higher risk of developing coronary heart disease (CHD) than controls [RR, 1.14; 95% confidence interval (CI), 1.07-1.21; P<0.001]. Case-control studies (1423 patients) showed an even greater risk of developing CHD (OR, 2.22; 95% CI, 1.59-3.117; P<0.001). The prevalence of CHD in the cross-sectional studies (17 724 patients) was significantly greater in individuals with PD than in those with no PD (OR, 1.59; 95% CI, 1.33-1.91; P<0.001). Analysing the relationship between number of teeth and incidence of CHD found a 1.24-fold increased risk (95% CI, 1.14-1.36; P<0.0001) of development of CHD in people who had <10 teeth.

This study suggests a possible association between PD and CHD. Elevated levels of inflammatory mediators in people who have PD suggest a role in atherothrombogenesis leading to CHD. Well-designed prospective cohort studies, with uniform definitions of PD and CHD, investigating the role of periodontal pathogen-burden on the occurrence of CHD and the management of patients with PD to reduce the future risk of development of CHD, are necessary.