Periodontal Disease and Heart Failure: Current Evidence and Perspectives

Periodontal disease has been increasingly recognized as a chronic inflammatory condition with potential systemic implications, particularly in the cardiovascular system. Heart failure (HF), a pro-inflammatory syndrome with multisystem involvement, remains a major public health burden. This state-of-the-art narrative review aims to analyze the current scientific evidence on the association between periodontal disease and heart failure, emphasizing epidemiological data, cardiac biomarkers, inflammatory mediators, and future perspectives.

Current evidence indicates a high prevalence of periodontal disease among patients with HF and suggests associations between periodontal disease and elevated cardiac biomarkers, including NT-proBNP and troponin T, as well as systemic inflammatory mediators such as C-reactive protein, IL-6, and TNF-α. Interventional studies have reported reductions in some of these biomarkers following periodontal treatment, suggesting a potential biological link between periodontal inflammation and HF. However, findings remain heterogeneous, and some studies have failed to demonstrate significant associations. Current evidence supports an association between periodontal disease and heart failure, with systemic inflammation representing a potential biological link. Nevertheless, the heterogeneity of study designs, small sample sizes, and predominance of observational and cross-sectional evidence limit causal inference. Longitudinal studies and randomized clinical trials are needed to clarify causal mechanisms and determine whether periodontal prevention and treatment can contribute to integrated strategies for patients with HF.