Association Between Periodontitis and Ischemic Heart Disease

Ischemic heart disease (IHD) is a leading cause of global mortality. This study examined the association between periodontitis severity, graded by clinical attachment loss (CAL), and IHD in a representative sample of US adults.

We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) 2013-2014 cycle, including a full-mouth periodontal examination, of participants aged ≥30 years with complete periodontal and IHD data (n = 2807; weighted n ≈ 122,396,066). Periodontal status was classified by maximum interdental CAL, using the severity thresholds of the 2018 classification of periodontal diseases: no-or-initial-attachment loss (CAL ≤2 mm; reference), Stage II periodontitis (CAL 3-4 mm), and Stage III/IV periodontitis (CAL ≥5 mm). IHD was defined as a composite of self-reported coronary heart disease, angina, or heart attack. Weighted prevalence of IHD was computed for each periodontal group, and survey-weighted logistic regression estimated odds ratios (ORs) for IHD, adjusting sequentially for demographic characteristics (age, sex, race/ethnicity, and family income), smoking, diabetes, hypertension, and other cardiovascular risk factors.

The weighted prevalence of IHD was 5.71% overall and increased across periodontal groups: 2.45% (no-or-initial-attachment loss), 4.66% (Stage II), and 8.82% (Stage III/IV) (p = 0.0004). In unadjusted models, Stage III/IV periodontitis was associated with higher odds of IHD than no-or-initial-attachment-loss (OR 3.84; 95% confidence interval [CI] 1.33-11.07; p = 0.003). After full adjustment, the association was attenuated, but the point estimate remained elevated (OR 1.47; 95% CI 0.40-5.39; p = 0.05). Older age, current smoking, diabetes, hypertension, and self-reported bone loss were independent predictors of IHD.

In this nationally representative study, Stage III/IV periodontitis was associated with a higher prevalence of IHD. Although the association was attenuated after multivariable adjustment, the findings suggest a potential link, possibly mediated by shared risk factors and inflammatory pathways.