Association between periodontitis and heart failure in the general population
Related Experiment Video
Updated: Aug 28, 2025
Robust Ligature-Induced Model of Murine Periodontitis for the Evaluation of Oral Neutrophils
Published on: January 21, 2020
Carolin Walther1, Jan-Per Wenzel2,3,4, Renate B Schnabel2,4,5
1Department of Periodontics, Preventive and Restorative Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Insights
Severe periodontitis is linked to heart failure with mid-range and reduced ejection fraction (HF(m)rEF). This study highlights a potential connection between severe gum disease and specific cardiac conditions, suggesting a need for integrated medical and dental care.
Area of Science:
- Cardiology
- Periodontology
- Public Health
Background:
- Limited data exists on the association between periodontitis and preclinical cardiac alterations.
- Periodontitis, a severe gum disease, may impact cardiovascular health.
- Understanding this link is crucial for early detection and prevention of heart conditions.
Purpose of the Study:
- To investigate the association between periodontitis and cardiac changes using transthoracic echocardiography.
- To determine if periodontitis is linked to different heart failure (HF) phenotypes, including HF with preserved ejection fraction (HFpEF) and HF with mid-range and reduced ejection fraction (HF(m)rEF).
Main Methods:
- Utilized data from the population-based Hamburg City Health Study, including 6209 participants with periodontal screening and transthoracic echocardiography.
- Classified periodontitis severity (none/mild, moderate, severe) and heart failure phenotypes according to 2021 ESC HF guidelines.
- Performed statistical analysis, adjusting for multiple cardiovascular risk factors to assess the association between periodontitis and HF phenotypes.
Main Results:
- Severe periodontitis was significantly associated with HF(m)rEF (OR: 3.16; 95% CI: 1.21, 8.22; P=0.019) after adjusting for confounders.
- No significant association was found between periodontitis and HFpEF or HF in general.
- Participants with severe periodontitis exhibited a higher burden of cardiovascular risk factors.
Conclusions:
- Severe periodontitis is significantly associated with HF(m)rEF, suggesting a potential link between severe gum disease and this specific type of heart failure.
- The findings indicate that individuals with severe periodontitis may require closer monitoring for cardiac health.
- Further research is needed to explore the role of systemic inflammation as a potential mediator between periodontitis and heart failure.
Aims:
Data on the association between periodontitis and preclinical cardiac alterations remain scarce. The aim of the current study is to determine if periodontitis is associated with morphological and functional cardiac changes measured by transthoracic echocardiography as well as different heart failure (HF) phenotypes.
Methods:
Participants from the population-based Hamburg City Health Study [ClinicalTrial.gov (NCT03934957)], who underwent transthoracic echocardiography and periodontal screening were included. Periodontitis was classified according to Eke and Page (none/mild, moderate, severe). The 2021 ESC HF guidelines were applied and HF was classified into HF with preserved ejection fraction (HFpEF, ejection fraction ≥50%), HF with mid-range and reduced ejection fraction [HF(m)rEF, ejection fraction <50%], and HF in general [HFpEF and HF(m)rEF]. Due to limited size, all subjects with LVEF <50% and symptoms or signs of HF were classified as HF with reduced and mildly reduced ejection fraction [HF(m)rEF].
Results:
Within 6209 participants with full periodontal examination, we identified an overlap of n = 167 participants with periodontitis and HF. Participants with severe periodontitis showed a higher burden of cardiovascular risk factors (men at advanced age, diabetes mellitus, hypertension) when compared with participants with none/mild periodontitis. After adjustment for age, sex, body mass index, smoking, diabetes, hypertension, atrial fibrillation, and coronary artery disease, severe periodontitis was significantly associated with HF(m)rEF (odds ratio: 3.16; 95% CI: 1.21, 8.22; P = 0.019), although no association was found for HFpEF and HF in general.
Conclusions:
The current study demonstrated that severe periodontitis was significantly associated with HF(m)rEF, although no relevant associations were found with HFpEF and HF in general as well as echocardiographic variables. The results implicate a potential target group, who need special attention from cooperating physicians and dentists. Future studies are warranted to verify whether systemic inflammation could be the link between the two diseases.
Related Concept Videos
01:27Heart Failure I: Introduction
01:17Pathophysiology of Heart Failure
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:23Rheumatic Heart Disease I: Introduction
01:29Heart Failure II: Pathophysiology
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies