PERIODONTITIS AND CARDIOVASCULAR DISEASE: A NARRATIVE REVIEW OF EVIDENCE FROM PUBLISHED META-ANALYSES, CONSENSUS REPORTS AND INTERVENTION STUDIES
Keywords:
periodontitis; cardiovascular diseases; coronary heart disease; stroke; heart failure; Mendelian randomization; narrative reviewAbstract
Background: Periodontitis affects more than one billion people worldwide and has been linked to cardiovascular disease (CVD) in many observational studies. Whether the link is causal, and whether periodontal treatment reduces cardiovascular risk, remains debated.
Aim: To review published evidence on the association between periodontitis and cardiovascular outcomes, the proposed biological mechanisms, the effect of periodontal therapy, and the evidence for causality.
Methods: A structured narrative review was conducted. Meta-analyses, consensus reports, Mendelian randomization (MR) studies, randomized-trial syntheses and global burden estimates were identified through seven structured web-based queries returning Pub Med/PMC and publisher pages (September 2026), plus earlier exploratory queries and citation searching. Effect estimates were extracted and synthesized thematically; overlapping meta-analyses were compared rather than re-pooled.
Results: The global burden of severe periodontitis was about 1.07 billion cases in 2021. Meta-analyses of cohort studies report a 13–34% higher relative risk of cardiovascular events in people with periodontitis; the largest (39 cohorts, 4,389,263 participants) found RR 1.24 for major adverse cardiovascular events, 1.26 for stroke and 1.42 for cardiac death. Case-control and cross-sectional studies gave larger estimates than cohorts (OR up to 2.93 vs 1.18 for myocardial infarction). Periodontitis was also associated with heart failure (RR 1.58) and atrial fibrillation (HR 1.03–1.31). Periodontal therapy lowered systolic blood pressure by 4.64 mmHg and C-reactive protein by 0.58 mg/L in a meta-analysis of 12 trials, but no adequately powered trial has shown reduced cardiovascular events. Most MR studies found no evidence of a causal effect.
Conclusion: Periodontitis is a consistent marker of higher cardiovascular risk, and professional bodies recommend informing patients accordingly. Causality remains unproven, and trials of periodontal therapy with hard cardiovascular endpoints are needed.
