Periodontal disease linked to heart failure – New study report

Periodontal disease linked to heart failure – New study report

Periodontal disease is known to be associated with coronary artery disease as well as poses a risk for bacteremia and subsequent risks [1]. A recent report looked at 6707 participants of the ARIC (Atherosclerosis Risk In Communities) study who had full-mouth periodontal examination at visit 4 between 1996-1998 and longitudinal follow up for incident heart failure. Data on incident heart failure was checked from visit 4 to 2018. In addition data on incident heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) between 2005-2018 was also analyzed [2].

Periodontal status was classified as healthy, periodontal disease or edentulous as per the Periodontal Profile Classification. Association between these Periodontal Profile Classification levels and incident heart failure, HFpEF and HFrEF were calculated. Biomarker of inflammation C-reactive protein (CRP) and biomarker of congestion N-terminal brain natriuretic peptide (NT-proBNP) were assessed.

Of the total 1,178 incident heart failure, 350 were HFpEF, 319 HFrEF and 509 of unknown type, over a median period of 13 years. 59% of these cases had periodontal disease while 18% were edentulous. Both periodontal disease and edentulism was thus associated with increased risk for all varieties of heart failure. In addition, edentulism was associated with unfavourable change in CRP and NT-proBNP while periodontal disease was only associated with CRP.

A scientific statement from the American Heart Association in 2012 had concluded that observational studies supported an association between periodontal disease and atherosclerotic cardiovascular disease independent of known confounders. But they do not support a causative relationship. Another conclusion was that although periodontal interventions reduced systemic inflammation and endothelial dysfunction in short term studies, there is no evidence that they prevent atherosclerotic cardiovascular disease or modify its outcomes [3].

Though inflammation is a physiological protective response intended to provide protection and promote healing, sometimes it can be counterproductive. Inflammatory cytokines exert direct effects on myocardial cells that predispose individuals to heart failure [4]. A randomized study of 58 patients with type 2 diabetes mellitus and periodontitis has shown that non-surgical periodontal therapy may improve cardiac diastolic function in type 2 diabetic patients with periodontitis [5].

Authors of the current study concluded by saying that if future studies provide causal association, population level implications could be notable, given the high prevalence of treatable periodontal disease and the burden of heart failure in the aging society [2].

References

1. Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. J Gen Intern Med. 2008 Dec;23(12):2079-86. doi: 10.1007/s11606-008-0787-6. Epub 2008 Sep 20. PMID: 18807098; PMCID: PMC2596495.
2. Molinsky RL, Yuzefpolskaya M, Norby FL, Yu B, Shah AM, Pankow JS, Ndumele CE, Lutsey PL, Papapanou PN, Beck JD, Colombo PC, Demmer RT. Periodontal Status, C-Reactive Protein, NT-proBNP, and Incident Heart Failure: The ARIC Study. J Am Coll Cardiol HF (Just Accepted) https://www.jacc.org/doi/full/10.1016/j.jchf.2022.05.008 Accessed on 25 September 2022.
3. Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, Taubert KA, Newburger JW, Gornik HL, Gewitz MH, Wilson WR, Smith SC Jr, Baddour LM; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation. 2012 May 22;125(20):2520-44. doi: 10.1161/CIR.0b013e31825719f3. Epub 2012 Apr 18. PMID: 22514251.
4. Wu CK, Lee JK, Chiang FT, Yang CH, Huang SW, Hwang JJ, Lin JL, Tseng CD, Chen JJ, Tsai CT. Plasma levels of tumor necrosis factor-α and interleukin-6 are associated with diastolic heart failure through downregulation of sarcoplasmic reticulum Ca2+ ATPase. Crit Care Med. 2011 May;39(5):984-92. doi: 10.1097/CCM.0b013e31820a91b9. PMID: 21263314.
5. Wang Y, Liu HN, Zhen Z, Pelekos G, Wu MZ, Chen Y, Tonetti M, Tse HF, Yiu KH, Jin L. A randomized controlled trial of the effects of non-surgical periodontal therapy on cardiac function assessed by echocardiography in type 2 diabetic patients. J Clin Periodontol. 2020 Jun;47(6):726-736. doi: 10.1111/jcpe.13291. Epub 2020 Apr 29. PMID: 32350903.