Non-Cochrane · aetiology · PM42393662
Periodontitis as an independent risk factor for cardiovascular disease: a systematic review and meta-analysis.
Alam Mohammad Khursheed, Hajeer Mohammad Younis, Abutayyem Huda, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-08890-7
Findings
Population Adults (>=18 years) free of prior major cardiovascular events
15 findings
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) 11-20 years · Follow-up 11-20 years | HR 1.35 [1.11, 1.58] GRADE not reported 15 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Confirmed major cardiovascular outcomes (MI, stroke, MACE, CV mortality) Sensitivity: confirmed major cardiovascular outcomes only | HR 1.33 [1.14, 1.52] GRADE not reported 22 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) Region: Western cohorts (North America, Australia, Europe) | HR 1.34 [1.13, 1.55] GRADE not reported 20 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) Combined effect, follow-up subgroup model | HR 1.30 [1.01, 1.58] GRADE not reported 30 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) <10 years · Follow-up < 10 years | HR 1.10 [0.81, 1.39] GRADE not reported 8 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) Region: East Asian populations | HR 1.21 [0.87, 1.55] GRADE not reported 10 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident myocardial infarction / coronary heart disease Outcome type: myocardial infarction / CHD | HR 1.34 [0.85, 1.83] GRADE not reported 10 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) | HR 1.31 [1.13, 1.48] GRADE not reported 30 studies · 3577135 participants |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) Combined effect, outcome-type subgroup model | HR 1.29 [1.17, 1.41] GRADE not reported 30 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident composite cardiovascular disease Outcome type: composite cardiovascular outcomes | HR 1.26 [1.09, 1.43] GRADE not reported 14 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) >20 years · Follow-up > 20 years | HR 1.70 [0.94, 2.45] GRADE not reported 7 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) Trim-and-fill adjusted (12 imputed studies) | HR 1.18 [1.01, 1.34] GRADE not reported 30 studies |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) Combined effect, region subgroup model (random effects, separate tau) | HR 1.30 [1.18, 1.42] GRADE not reported 30 studies · 3577135 participants |
| Periodontal/oral health-related exposure (periodontitis, tooth loss, edentulism, self-reported or coded periodontal disease) | No or mild periodontitis / good periodontal health | Incident stroke Outcome type: stroke | HR 1.63 [0.84, 2.43] GRADE not reported 6 studies |
| Clinically diagnosed or periodontitis-coded periodontitis (excluding tooth loss, edentulism and non-specific poor oral health as sole exposure) | No or mild periodontitis / good periodontal health | Incident cardiovascular disease (all reported cardiovascular outcomes) Sensitivity: clinically diagnosed or periodontitis-coded exposure only | HR 1.36 [1.15, 1.57] GRADE not reported 18 studies |
Included primary studies 30
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Batty 2018 Oral health and later coronary heart disease: Cohort study of one million people. PMID:29461088 | 2018 | 1 other review | not stated | not extracted yet |
| Dietrich 2008 Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease. PMID:18362228 | 2008 | 1 other review | not stated | not extracted yet |
| Joshy 2016 Is poor oral health a risk marker for incident cardiovascular disease hospitalisation and all-cause mortality? Findings from 172 630… PMID:27577588 | 2016 | 1 other review | not stated | not extracted yet |
| LaMonte 2017 History of Periodontitis Diagnosis and Edentulism as Predictors of Cardiovascular Disease, Stroke, and Mortality in Postmenopausal Women. PMID:28356279 | 2017 | 1 other review | not stated | not extracted yet |
| Lin 2019 Dental treatment procedures for periodontal disease and the subsequent risk of ischaemic stroke: A retrospective population-based cohort… PMID:30989681 | 2019 | 1 other review | not stated | not extracted yet |
| Mucci 2009 Do genetic factors explain the association between poor oral health and cardiovascular disease? A prospective study among Swedish twins. PMID:19648170 | 2009 | 1 other review | not stated | not extracted yet |
| Noguchi 2015 Five-year follow-up study of the association between periodontal disease and myocardial infarction among Japanese male workers: MY Health… PMID:25293424 | 2015 | 1 other review | not stated | not extracted yet |
| Rivas-Tumanyan 2012 Periodontal disease and incidence of hypertension in the health professionals follow-up study. PMID:22476024 | 2012 | 1 other review | not stated | not extracted yet |
| Sen 2018 Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke. PMID:29335336 | 2018 | 1 other review | not stated | not extracted yet |
| Tu 2007 Associations between tooth loss and mortality patterns in the Glasgow Alumni Cohort. PMID:17164486 | 2007 | 1 other review | not stated | not extracted yet |
| Abnet 2005 Tooth loss is associated with increased risk of total death and death from upper gastrointestinal cancer, heart disease, and stroke in a… PMID:15659476 | 2005 | this review only | not stated | not extracted yet |
| Bengtsson 2021 Periodontitis related to cardiovascular events and mortality: a long-time longitudinal study. PMID:33506429 | 2021 | this review only | not stated | not extracted yet |
| Beukers 2017 Periodontitis is an independent risk indicator for atherosclerotic cardiovascular diseases among 60 174 participants in a large dental… PMID:27502782 | 2017 | this review only | not stated | not extracted yet |
| Chen 2016 Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study. PMID:27798703 | 2016 | this review only | not stated | not extracted yet |
| Choe 2009 Tooth loss, hypertension and risk for stroke in a Korean population. PMID:19013571 | 2009 | this review only | not stated | not extracted yet |
| Chou 2015 Major Adverse Cardiovascular Events in Treated Periodontitis: A Population-Based Follow-Up Study from Taiwan. PMID:26114433 | 2015 | this review only | not stated | not extracted yet |
| Hansen 2016 Relation of Periodontitis to Risk of Cardiovascular and All-Cause Mortality (from a Danish Nationwide Cohort Study). PMID:27372888 | 2016 | this review only | not stated | not extracted yet |
| Heitmann 2008 Remaining teeth, cardiovascular morbidity and death among adult Danes. PMID:18534671 | 2008 | this review only | not stated | not extracted yet |
| Holmlund 2017 Oral health and cardiovascular disease risk in a cohort of periodontitis patients. PMID:28531825 | 2017 | this review only | not stated | not extracted yet |
| Howell 2001 Periodontal disease and risk of subsequent cardiovascular disease in U.S. male physicians. PMID:11216961 | 2001 | this review only | not stated | not extracted yet |
| Hujoel 2001 Examining the link between coronary heart disease and the elimination of chronic dental infections. PMID:11480641 | 2001 | this review only | not stated | not extracted yet |
| Hung 2003 Oral health and peripheral arterial disease. PMID:12615794 | 2003 | this review only | not stated | not extracted yet |
| Hung 2004 The association between tooth loss and coronary heart disease in men and women. PMID:15562943 | 2004 | this review only | not stated | not extracted yet |
| Jimenez 2009 Periodontitis and incidence of cerebrovascular disease in men. PMID:19847898 | 2009 | this review only | not stated | not extracted yet |
| Joshipura 2003 Periodontal disease, tooth loss, and incidence of ischemic stroke. PMID:12511749 | 2003 | this review only | not stated | not extracted yet |
| Lee 2015 Dental prophylaxis decreases the risk of acute myocardial infarction: a nationwide population-based study in Taiwan. PMID:25609934 | 2015 | this review only | not stated | not extracted yet |
| Lee 2017 Association between periodontal disease and non-communicable diseases: A 12-year longitudinal health-examinee cohort study in South Korea. PMID:28658175 | 2017 | this review only | not stated | not extracted yet |
| Tiensripojamarn 2021 Periodontitis is associated with cardiovascular diseases: A 13-year study. PMID:33386631 | 2021 | this review only | not stated | not extracted yet |
| Wu 2000 Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study. PMID:11025784 | 2000 | this review only | not stated | not extracted yet |
| Yu 2015 Cardiovascular risks associated with incident and prevalent periodontal disease. PMID:25385537 | 2015 | this review only | not stated | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Adults (>=18 years) without prior major cardiovascular events at baseline | Adults, 30 cohort studies, over 3.5 million participants (n=30) |
| Intervention | Clinically diagnosed periodontitis or severe gingivitis (AAP/CDC definitions, PPD >=4 mm, CAL >=3 mm); tooth loss, edentulism, self-reported or coded periodontal disease eligible for broader analysis | Periodontal/oral health-related exposure including periodontitis, tooth loss/edentulism, self-reported and administrative-coded disease (n=30) |
| Comparison | No or mild periodontitis / good periodontal health | No or mild periodontitis / good periodontal health |
| Outcomes | Incident fatal or non-fatal MI, ischemic stroke, MACE or cardiovascular mortality | Incident cardiovascular disease, stroke, MI/CHD, composite outcomes, cardiovascular mortality (n=30) |
| Study designs | Longitudinal cohort studies (cross-sectional studies excluded) | 30 observational cohort studies (prospective and retrospective) |
| Timing | Not specified | Follow-up 5 to 57 years |