Elsevier

American Heart Journal

Volume 154, Issue 5, November 2007, Pages 830-837
American Heart Journal

The prevalence and incidence of coronary heart disease is significantly increased in periodontitis: A meta-analysis

https://doi.org/10.1016/j.ahj.2007.06.037Get rights and content

Background

Previous studies have shown conflicting results as to whether periodontitis (PD) is associated with increased risk of coronary heart disease (CHD). The aim of the current study was to evaluate whether such an association exists.

Methods

A systematic review of the literature revealed 5 prospective cohort studies (follow-up >6 years), 5 case-control studies, and 5 cross-sectional studies that were eligible for meta-analysis. Individual studies were adjusted for confounding factors such as age, sex, diabetes mellitus, and smoking. The 3 study categories were analyzed separately. Heterogeneity of the studies was assessed by Cochran Q test. The studies were homogeneous; therefore, the Mantel-Haenszel fixed-effect model was used to compute common relative risk and odds ratio (OR).

Results

Meta-analysis of the 5 prospective cohort studies (86 092 patients) indicated that individuals with PD had a 1.14 times higher risk of developing CHD than the controls (relative risk 1.14, 95% CI 1.074-1.213, P < .001). The case-control studies (1423 patients) showed an even greater risk of developing CHD (OR 2.22, 95% CI 1.59-3.117, P < .001). The prevalence of CHD in the cross-sectional studies (17 724 patients) was significantly greater among individuals with PD than in those without PD (OR 1.59, 95% CI 1.329-1.907, P < .001). When the relationship between number of teeth and incidence of CHD was analyzed, cohort studies showed 1.24 times increased risk (95% CI 1.14-1.36, P < .0001) of development of CHD in patients with <10 teeth.

Conclusions

This meta-analysis indicates that both the prevalence and incidence of CHD are significantly increased in PD. Therefore, PD may be a risk factor for CHD. Prospective studies are required to prove this assumption and evaluate risk reduction with the treatment of PD.

Section snippets

Literature search and study selection

Literature searches were done by investigators (A. B. and R. A.) using the PubMed computerized database (1966-2006), Cochrane Controlled Trials Register (1970-2006), EMBASE (1980-2006), and CINAHL (1982-2006). The search was restricted to the articles including human subjects. In addition, manual searches were performed through the reference lists of published articles and review papers. Any unpublished studies were excluded.

For oral pathology, the following terms were used: periodontal disease

Results

As shown in Figure 1, meta-analysis of the 5 prospective cohort studies (86 092 patients) indicated that individuals with PD had a 1.14 times higher risk of developing CHD than the controls (95% CI 1.074-1.213, P < .001). DeStefano et al,9 Mattila et al,10 and Wu et al12 found that this risk ratio is significant. However, Howell et al 13 and Joshipura et al11 found that this risk ratio was not significant. One of the possible explanations they provide for the negative results is that some of the

Discussion

Our results indicate that there is a statistically significant positive correlation between periodontal disease and CHD. Both the incidence and prevalence of CHD are increased in patients who are affected with periodontal disease.

Coronary heart disease is a multifactorial disease. Various risk factors such as age, sex, family history of heart disease, smoking, alcohol intake, DM, exercise, obesity, and high blood pressure play a role in the pathogenesis of CHD. Most of the studies included in

Conclusions

Our analysis suggests possible association between PD and CHD. Elevated levels of inflammatory mediators in patients with PD suggest their role in atherothrombogenesis leading to CHD. Future well-designed prospective cohort studies with uniform definitions of periodontal disease and CHD investigating the definite role of periodontal pathogen burden on the occurrence of CHD and management of patients with PD to reduce the future risk of development of CHD are necessary.

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