Periodontitis as an independent risk factor for cardiovascular disease: a systematic review and meta-analysis

OBJECTIVE: A substantial body of evidence suggests that oral health, particularly periodontitis, is closely linked to overall systemic well-being. This systematic review and meta-analysis evaluate the specific relationship between this chronic inflammatory oral condition and the onset of new cardiovascular events. METHOD: Adhering to PRISMA guidelines, a thorough literature search of major databases from 2000 to 2024 was performed to identify relevant cohort studies involving adults free from pre-existing cardiovascular disease. The methodological rigor of the included studies was appraised using the ROBINS-E tool. The main pooled estimate included all 30 qualifying cohort studies and is therefore reported as a broader periodontal/oral health-related exposure analysis. Restricted sensitivity analyses were conducted for clinically diagnosed or periodontitis-coded exposure and for confirmed major cardiovascular outcomes. RESULTS: The analysis found that periodontal/oral health-related exposure was associated with a 31% elevated risk of developing cardiovascular disease (HR = 1.31, 95% CI: 1.13-1.48). The link was most potent for stroke and demonstrated a dose-response pattern, where greater disease severity correlated with higher risk. Interventions like periodontal treatment were correlated with a decrease in risk. Significant heterogeneity was noted, largely due to variations in study design. CONCLUSION: In conclusion, the broader periodontal/oral health-related analysis showed a 31% elevated risk for cardiovascular disease, although substantial heterogeneity limits the interpretability of this estimate. Nevertheless, the findings underscore the importance of oral health management in comprehensive cardiovascular risk mitigation strategies. PROSPERO: Registration in the PROSPERO database was done before initiating the investigation [CRD420251173688].