Periodontal disease linked to increased risk of all subtypes of heart failure

USA: Periodontal condition was linked to all subtypes of heart failure [incident heart failure, heart failure with preserved ejection fraction (HFpEF), and heart failure with reduced ejection fraction (HFrEF)]. The condition was also linked to unfavorable C-reactive protein (CRP) and N-terminal brain natriuretic peptide (NT-proBNP) alterations.

These are the findings from the study undertaken by the team under Rebecca Molinsky and published in the Journal of American College of Cardiology: Heart Failure.

Periodontal disease (PD), which is caused by an inflammatory host response to dysbiotic subgingival microbiota, has been linked to cardiovascular disease. However, the relationship between PD and heart failure and its subtypes has not been studied.

A total of 6,707 ARIC (Atherosclerosis Risk In Communities) research participants (mean age 63 ± 6 years) were included, with a full-mouth periodontal examination at visit 4 (1996-1998) and longitudinal follow-up for any incident HF (visit 4 to 2018), or incident HFpEF and HFrEF (2005-2018).

Periodontal state was divided into three categories: healthy, PD (Periodontal Profile Classification), and edentulous. The HRs and 95 percent CIs for the link between Periodontal Profile Classification levels and incident HF, HFpEF, or HFrEF were calculated using multivariable-adjusted Cox proportional hazards models. Biomarkers of inflammation (C-reactive protein) and congestion (N-terminal brain natriuretic peptide) were also measured.

The key points of this study were as follows:

1. Over a median of 13 years, there were 1,178 incident HF cases (350 HFpEF, 319 HFrEF, and 509 HF of uncertain kind).

2. 59% of these individuals had Parkinson's disease, whereas 18% were edentulous.

3. PD was linked to a higher risk of HFpEF and a considerably higher risk of HFrEF, as did edentulism: HFpEF, HFrEF.

4. Edentulism was related to an increase in CRP and NT-proBNP, but PD was solely associated with CRP.

In conclusion, given the evidence linking inflammation to periodontal disease and HF, as well as the established capacity to reduce inflammation by acting on oral dysbiosis, the possibility for anti-infective periodontal treatment to minimize the risk of HF development warrants further research.

Reference:

Molinsky, R. L., Yuzefpolskaya, M., Norby, F. L., Yu, B., Shah, A. M., Pankow, J. S., Ndumele, C. E., Lutsey, P. L., Papapanou, P. N., Beck, J. D., Colombo, P. C., & Demmer, R. T. (n.d.). Periodontal status, C-reactive protein, NT-proBNP, and incident heart failure. JACC: Heart Failure, 0(0). https://doi.org/10.1016/j.jchf.2022.05.008