Introduction
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide, and substantial resources are invested in treating its complications. Identifying ASCVD risk factors and implementing effective prevention and treatment strategies are essential to addressing this major health concern.
Evidence of possible associations between periodontal disease and ASCVD continues to increase. Proposed mechanisms include bacteremia, vascular infection, and systemic inflammation. Preventing and treating periodontal disease may therefore help reduce the burden of ASCVD.
A previous American Heart Association scientific statement found the evidence supported an association between periodontal disease and ASCVD. However, it also emphasized the need for stronger evidence on clinical outcomes and on whether periodontal treatment improves ASCVD outcomes.
Objectives
This updated American Heart Association scientific statement reviews new evidence on the potential relationship between periodontal disease and ASCVD, the mechanisms that may underlie this association, and the possible cardiovascular benefits of periodontal treatment. It also examines disparities in periodontal disease prevalence, particularly among under-resourced populations, and identifies priorities for further research.
Discussion
ASCVD comprises chronic conditions caused by plaque buildup in arterial walls, including ischemic heart disease, cerebrovascular disease, and peripheral artery disease. These conditions can lead to acute events such as coronary artery disease, myocardial infarction, and stroke.
Periodontal disease is a multifactorial chronic inflammatory condition. It typically begins with dental plaque biofilm-induced gingival inflammation and bleeding, then may progress to loss of clinical attachment, gingival recession, deepened periodontal pockets, and destruction of tooth-supporting alveolar bone. Severe periodontitis can cause tooth mobility and loss, as well as masticatory dysfunction that affects nutrition, quality of life, and social well-being.
Periodontal disease is more prevalent among people with poor oral hygiene and cardiovascular risk factors such as hypertension, overweight or obesity, diabetes, and smoking. Prevalence is also higher among males, older adults, people with low levels of physical activity, and those affected by adverse social determinants of health, including lower socioeconomic status, food insecurity, and limited access to medical and oral health care.
Although periodontal disease and ASCVD share several risk factors, emerging evidence suggests an independent association between them. Possible biological mechanisms include direct pathways, such as bacteremia and vascular infection, and indirect pathways, particularly chronic systemic inflammation.
Numerous studies associate periodontal disease with an increased risk of myocardial infarction, stroke, atrial fibrillation, heart failure, peripheral artery disease, chronic kidney disease, and cardiac death. Periodontal disease contributes to chronic inflammation associated with ASCVD, but a causal relationship has not been established.
No direct evidence currently shows that periodontal treatment prevents cardiovascular disease. Nevertheless, treatments that reduce lifetime inflammation exposure appear to lower risk of developing ASCVD. Treating and controlling periodontal disease and its associated inflammation may therefore support ASCVD prevention and management.
People with one or more cardiovascular risk factors are at higher risk and may benefit from regular oral health screening and targeted periodontal care to address chronic inflammation. Previous studies have also associated more frequent toothbrushing with lower 10-year ASCVD risk and reduced inflammatory markers.
Summary
ASCVD remains the leading cause of death worldwide. This scientific statement advances understanding of the growing evidence linking periodontal disease and cardiovascular disease and describes potential mechanisms underlying that association. Current evidence does not establish causation, and the effect of periodontal treatment on cardiovascular events remains inconclusive. However, strong evidence indicates that periodontal treatment improves intermediate outcomes, including blood pressure, high-density lipoprotein cholesterol levels, and inflammatory markers. Because these measures are associated with future cardiovascular risk, they may help explain the relationship between periodontal disease and ASCVD.
Further research, including long-term studies and randomized controlled trials, is needed to determine whether periodontal treatment affects ASCVD progression and outcomes. Research should also examine how socioeconomic status, access to oral health care, and other social determinants influence both conditions. These findings could inform targeted prevention and treatment strategies to reduce the prevalence and adverse effects of periodontal disease and ASCVD.
