The Link Between Periodontal Disease And Cardiovascular Disease

A new study reported in the European Journal of Preventive Cardiology has identified periodontal disorders like gingivitis and tooth loss as a potential risk marker for cardiovascular disease. 

The study took a look at 15,000 patients with chronic coronary heart disease as well as information about their dental health. The results were that indicators of periodontal disease, such as bleeding gums and fewer remaining teeth, were common.

This group was also associated with numerous cardiovascular and socioeconomic risk factors. The findings suggest common risk factors for dental disease and coronary heart disease. They also raise the question of whether self-described dental health can now be considered a useful marker of cardiovascular disease risk.

A lower prevalence of tooth loss was associated with lower levels of cardiovascular disease risk factors waist circumference, systolic blood pressure, lower glucose levels and low-density lipoprotein cholesterol levels. Also less prevalent among patients with more teeth was diabetes and smoking, however, the likelihood of work stress, higher education and alcohol consumption was greater.

While there was some variation in these results depending on region, country and ethnic group with the highest rates of tooth loss and bleeding gums found in Eastern Europe increasing prevalence of tooth loss was significantly associated with higher fasting glucose levels, LDL cholesterol levels, systolic blood pressure, and waist circumference. A higher prevalence of gum bleeding was significantly associated with higher LDL cholesterol levels and systolic blood pressure.

Other Results 

Results showed a high overall prevalence of tooth loss.

Overall, almost 70% of participants were current or former smokers.

16% reported having no teeth.

41% reported having fewer than 15% remaining teeth.

26% of the patients reported gum bleeding when brushing teeth.

The study was the largest of its kind to assess dental disease in coronary patients. It also demonstrates a heavier burden of cardiovascular disease risk factors and higher levels of biomarkers among those with more tooth loss and gum bleeding even after adjusting for confounders like age, smoking, diabetes and education level. 

The study used summarized information on self-reported dental health from the STABILITY trial. This was a clinical trial involving 15,828 participants from 39 countries. All the participants had chronic coronary heart disease and at least one additional risk factor for coronary heart disease. The participants all were given a blood test and a physical examination. They also completed a lifestyle questionnaire, which included information on dental health, and had to list their number of remaining teeth and frequency of gum bleeding.

The observed regional variations in the prevalence of periodontal disease might partly be explained by regional differences in cardiovascular risk factor prevalence such as smoking, suggest the study authors. They concede that such differences in prevalence indicate a complex relationship in which genetic, demographic and socioeconomic disparities are likely contributing factors. Smoking and lower levels of education were strongly associated with periodontal disease. Age and smoking are well known risk factors common to both periodontal and cardiovascular disease -- and with established biological explanations.

The evident and consistent relationship between self-reported dental status and cardiovascular risk in this population could point toward periodontal disease being a risk factor for incident coronary heart disease, says lead author Dr. Ola Vedin of the University of Uppsala, Sweden. He added that the observation that poor dental health among chronic coronary patients is linked to a heavier cardiovascular risk burden does not prove a casual link between the two conditions.

It is still a matter of debate whether periodontal disease is an independent risk factor for coronary heart disease, Vedin said. Some studies point to a modern association while others are contradictory. Our findings show an association between self-reported periodontal disease and several cardiovascular risk factors and as such lend support to a possible association between the conditions. Our findings also support the notion that periodontal disease and socioeconomic status are closely related."

While Vedin doesn't go so far as to advocate rigorous dental hygiene measures as a strategy to reduce cardiovascular risk, he and his colleagues were "astonished" by the high prevalence of severe tooth loss seen overall in the study, but "puzzled" by the marked differences in dental prevalence between countries, even within the same geographical region.

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