Periodontal Disease Linked to ASCVD due to shared pathways: Study
A trailblazing review proposed that poor oral health particularly periodontal disease can cause atherosclerotic cardiovascular disease (ASCVD) due to shared biological pathways like inflammation, immune response, and bacterial translocation. The study titled ‘Oral Health and Atherosclerotic Cardiovascular Disease: A Review’ was published in the American Journal of Preventive Cardiology.
Periodontal disease (PD) is a prevalent chronic infection of the gums and the surrounding bone seen in older adults that begins with the accumulation of dental plaque leading to gingivitis. Gingivitis, an inflammatory response can progress to PD potentially causing bone loss and tooth damage due to deeper penetration of the bacteria. Risk factors like smoking, diabetes, and poor oral hygiene many of which are also atherosclerotic cardiovascular risk factors may worsen the progression of PD. Additionally, an imbalance in oral flora (dysbiosis) can lead to bacteremia, the spread of bacteria in the bloodstream, prompting systemic inflammation that might link PD to ASCVD.
Mechanisms by which PD can lead to ASCVD:
- Direct translocation of bacteria like porphyromonas gingivalis into the bloodstream or through inflammatory or immune responses can affect cardiovascular health as periodontal bacteria have also been detected in the atheromatous plaques.
- Triggering of immune responses or inflammatory diseases by bacteria causing PD like the P.gingivals can activate immune cells like macrophages, T-cells, and B-cells which are in turn linked to atherosclerosis progression.
- PD can lead to increased platelet activity which can in turn cause thrombus formation and transient ischemic attacks increasing the risk of atherosclerotic cardiovascular disease.
- Impaired endothelial function leading to reduced vascular flexibility and increased oxidative stress can be caused by periodontal disease. Improved endothelial health was seen due to improved periodontal condition.
- Diabetes, smoking, dyslipidemia, hypertension, obesity, and poor diet are some of the common and shared risk factors that can increase the risk of ASCVD in poor periodontal health.
- Shared inflammatory pathways and biomarkers suggest a strong biological link between PD and ASCVD.
Supporting Data:
Literature in the past has also observed a positive association between PD and ASCVD with PD doubling the risk of myocardial infarction, peripheral arterial disease, and ischemic stroke. Oral health can have a long-term impact on vascular health as pediatric Oral infections are linked to increased carotid artery thickness in adulthood.
Thus, the researchers highlight that poor periodontal health can increase the risk of cardiovascular diseases. The authors call for increased awareness and preventive measures, especially in lower socio-economic areas where the risk of PD causing ASCVD is higher. Further research is needed to justify the etiology and the potential benefits of periodontal treatment in reducing cardiovascular diseases.
Further reading: Gianos E, Jackson EA, Tejpal A, et al. Oral health and atherosclerotic cardiovascular disease: A review. Am J Prev Cardiol. 2021;7:100179. Published 2021 Apr 5. doi:10.1016/j.ajpc.2021.100179
