ESC 2021: Patients with Prior Myocardial Infarction and Gum Disease Face Higher Risk of Heart Disease

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Periodontitis may be associated with an increased risk of cardiovascular disease (CVD), particularly among patients with a history of myocardial infarction (MI), suggests new research being presented at the European Society of Cardiology (ESC) Congress 2021, held virtually between August 27-30, 2021.

“Our study suggests that dental screening programmes including regular check-ups and education on proper dental hygiene may help to prevent first and subsequent heart events,” said study author Giulia Ferrannini, MD, PhD fellow, Karolinska Institute, Stockholm, Sweden, in an ESC press release.

Dr Ferrannini and colleagues conducted a follow-up to the Swedish Periodontitis and Its Relation to Coronary Artery Disease (PAROKRANK) study that previously showed the risk of a first MI was significantly increased in patients with periodontitis compared to their healthy peers of the same age, sex, and geographic location.

The current study investigated whether the presence of periodontitis, both in patients with MI and without MI (control group), was related to an increased risk of new cardiovascular (CV) events over time.

The analysis included 1587 participants (median age, 62 years) who underwent a CV and dental examination between 2010 and 2014, and were matched for gender, age, and living area.

Periodontitis status was categorized as either healthy (≥80% remaining alveolar bone height), moderate (79%-66% remaining alveolar bone height), or severe (<66% remaining alveolar bone height). Baseline periodontitis status was healthy in 985, moderate in 489, and severe in 113 participants.

The composite primary endpoint was the first of all-cause death, non-fatal MI or stroke, or severe heart failure until December 2018. Data on outcomes were provided by Swedish national death and patient registries, according to the study abstract.

During an average follow up of 6.2 years, there were 205 primary endpoint events, 158 CV events, and 68 deaths.

Researchers observed that participants with periodontitis at baseline had 49% higher odds of the primary endpoint compared to those without periodontitis. The probability of the primary endpoint increased as the severity of periodontitis rose, according to the abstract.

When participants with MI and those in the control group were assessed separately, the graded relationship between periodontitis severity and the primary endpoint was significant only for those with MI.

"We postulate that the damage of periodontal tissues in people with gum disease may facilitate the transfer of germs into the bloodstream. This could accelerate harmful changes to the blood vessels and/or enhance systemic inflammation that is harmful to the vessels," said Dr Ferrannini in the press release. "It is important to underline that the quality of care in Sweden is high, as confirmed by the overall low number of total events during follow-up. Despite this, gum disease was linked with an elevated likelihood of cardiovascular disease or death."

Reference: Ferrannini G, Norhammar A, Almosawi M, et al. Periodontitis and cardiovascular outcome - a prospective follow-up of the PAROKRANK cohort. Abstract presented at: ESC Congress 2021; August 25, 2021.