Periodontal Disease and Risk of Heart Failure: A Systematic Review and Meta-Analysis

Periodontal disease (PD) has been hypothesized to influence the risk of heart failure (HF), but the evidence remains inconclusive. We conducted a systematic review to evaluate the association between PD and HF. PubMed, Embase, Scopus, and Web of Science were searched from inception to October 2024. We selected cohort studies assessing the association between PD and HF in adults. Random effects models were used for all meta-analyses, and relative risks (RRs) were used to describe such associations. The risk of bias was evaluated using the Newcastle-Ottawa scale (NOS). Seven cohort studies (n = 376,166), including five prospective and two retrospective studies, were included. The studies had a mean age range of 43-65.3 years, with male representation ranging from 31.7% to 78%, and follow-up durations of 5.4-13 years. Among these, four studies were classified as low risk of bias, and three with unclear risk of bias. PD was associated with an increased risk of HF (crude RR 1.58, 95% confidence interval [CI] 1.20-2.07, p  < 0.01). Our findings suggest a potential association between PD and HF risk similar to a previous meta-analysis with fewer included individuals and without a quality assessment of the cohort studies. However, the limited number of cohort studies and significant heterogeneity warrant cautious interpretation. Further high-quality, longitudinal studies are needed to elucidate the nature and mechanisms of this relationship.