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Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?: A Scientific Statement From the American Heart Association
Study Questions:
Is there evidence for a causal link between periodontal disease (PD) and atherosclerotic vascular disease (ASVD)?
Methods:
Representatives from dental, infectious diseases, cardiology, and epidemiology communities convened a writing group charged with assessing the weight and scope of evidence for an association or causality of PD and ASVD. A series of literature searches was conducted for English language articles published between 1950 and July 2011 on the association between PD and any cerebrovascular, peripheral vascular, or cardiovascular disease, including clinical and animal studies and systematic reviews. The search produced a total of 537 peer-reviewed publications, of which 61% were in the dental and 39% in the medical literature. Only those specifically discussed in the present report were referenced (282 publications).
Results:
Available data indicate a general trend toward a periodontal treatment–induced suppression of systemic inflammation and improvement of noninvasive markers of ASVD and endothelial function. An association between PD and ASVD is supported by evidence that meets standards for Level of Evidence A. A benefit of periodontal intervention in decreasing local periodontal inflammation is also supported by level A evidence. However, effects of PD therapy on specific inflammatory markers are not consistent across studies, and their sustainability over time has not been established. PD is associated with ASVD independent of known confounders. But causation of ASVD by PD is not supported by either level A or level B evidence. The same is true about a benefit of periodontal intervention in decreasing long-term systemic inflammation.
Conclusions:
Although a contribution of PD to ASVD is biologically plausible, periodontal and cardiovascular diseases share multiple risk factors that are prevalent and powerful promoters of disease, including tobacco use, diabetes mellitus, and age.
Perspective:
As suggested in the scientific statement, association between PD and ASVD requires further study in well-designed controlled interventional studies. Such investigations should reflect the longitudinal effectiveness of different approaches to managing periodontal health, given the possibility of PD recurrence after therapy and the extended time course of evolution of ASVD and its manifestations.
Keywords: Inflammation, Peer Review, Research, Atherosclerosis, Periodontal Diseases, Cardiology, Cardiovascular Diseases, Tobacco Use, Tobacco Use Disorder, United States
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