Association between periodontitis and subclinical vascular dysfunction: a systematic review and meta-analysis

Periodontitis is a chronic inflammatory disease associated with cardiovascular disease, however, its relationship with early subclinical vascular changes remains not fully established. This study systematically evaluates the association between periodontitis and carotid intima-media thickness (CIMT) and endothelial function measured by flow-mediated dilation (FMD). A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science. Observational and interventional studies assessing the association between periodontitis and CIMT or FMD were included. Random-effects meta-analyses were performed to estimate pooled mean differences (MD) with 95% confidence intervals (CI). A total of 62 studies were included in the systematic review. Thirteen studies (n = 2301 participants) were included in the CIMT meta-analysis and five studies (n = 257 participants) in the FMD meta-analysis. Periodontitis was associated with higher CIMT (MD = 0.108 mm; 95% CI: 0.079 to 0.138) and lower FMD (MD = - 5.11%; 95% CI: -9.52 to - 0.71). Substantial between-study heterogeneity was observed across analyses. Periodontitis was associated with increased CIMT and reduced FMD, suggesting an association between periodontal disease and markers of subclinical vascular dysfunction. However, the predominantly observational evidence and substantial heterogeneity preclude causal inference. PROSPERO registration: CRD420251268261.