Scientific Statement Links Gum Disease to Increased Cardiovascular Risk

Increasing evidence associates gum disease with elevated risk of cardiovascular events including heart attack, stroke, atrial fibrillation, heart failure and cardiometabolic health conditions, according to a new scientific statement published in the American Heart Association's flagship journal Circulation. The statement suggests that effective prevention and treatment of periodontal disease could potentially decrease the burden of cardiovascular disease. The new American Heart Association scientific statement, "Periodontal Disease and Atherosclerotic Cardiovascular Disease," features new data supporting an association between periodontal disease and atherosclerotic cardiovascular disease (ASCVD) and updates the Association's 2012 scientific statement.

ASCVD, the leading cause of death globally, is caused by buildup of arterial plaque and refers to conditions that include coronary heart disease, stroke, peripheral artery disease and aortic aneurysms. Andrew H. Tran, M.D., M.P.H., M.S., FAHA, chair of the scientific statement writing group, emphasized the connection between oral and cardiovascular health, noting that gum disease and poor oral hygiene can allow bacteria to enter the bloodstream, causing inflammation that may damage blood vessels and increase heart disease risk. Regular brushing, flossing and dental checkups represent important components of heart protection beyond maintaining oral health.

Periodontal disease represents a chronic inflammatory condition affecting over 40% of U.S. adults over age 30. The earliest stage, gingivitis, involves inflammation of the gums due to buildup of oral plaque. Without treatment, gingivitis may progress to periodontitis, where gums pull away from teeth, forming pockets that trap bacteria and lead to infection. Severe periodontitis involves extensive damage to bones supporting teeth, potentially resulting in tooth loss. The condition appears more common in individuals with poor oral hygiene and cardiovascular disease risk factors including high blood pressure, overweight or obesity, diabetes and smoking.

Prevalence of periodontal disease remains higher among men, older adults, individuals with low physical activity, and people affected by adverse social determinants of health such as lower socioeconomic status, food insecurity and lack of access to health care including dental care. Although periodontal disease and ASCVD share common risk factors, emerging data indicates an independent association between the two conditions. Potential biological mechanisms linking periodontal disease with poor cardiovascular outcomes include direct pathways such as bacteria in the blood and vascular infections, along with indirect pathways involving chronic systemic inflammation.

Numerous studies have found periodontal disease associated with increased risk of heart attack, stroke, atrial fibrillation, heart failure, peripheral artery disease, chronic kidney disease and cardiac death. While periodontal disease clearly contributes to chronic inflammation associated with ASCVD, researchers have not confirmed a cause-and-effect relationship. No direct evidence exists that periodontal treatment will help prevent cardiovascular disease, though treatments reducing lifetime exposure to inflammation appear beneficial for reducing ASCVD risk. Treatment and control of periodontal disease and associated inflammation may contribute to prevention and improved management of ASCVD.

People with one or more cardiovascular disease risk factors are considered at higher risk and may benefit from regular dental screenings and targeted periodontal care to address chronic inflammation. Previous studies have found more frequent tooth brushing associated with lower 10-year ASCVD risk and reduced inflammatory markers. More research including long-term studies and randomized controlled trials is needed to determine whether periodontal treatment can impact ASCVD progression and outcomes. The role of socioeconomic status, access to dental care and other social factors that adversely affect health should be explored to develop targeted prevention and treatment strategies that can help reduce the prevalence and adverse outcomes of periodontal disease and ASCVD.