Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A systematic review.

BACKGROUND Recent studies implicate exposure to systemic conditions involving chronic inflammation, including chronic periodontitis, in the etiology of atherosclerosis. RATIONALE A systematic review of the literature was conducted to assess the association between chronic inflammatory periodontal disease and atherosclerosis. FOCUSED QUESTION Does periodontal disease influence the initiation/progression of atherosclerosis and, therefore, cardiovascular disease (CVD), stroke, and peripheral vascular disease (PVD)? SEARCH PROTOCOL MEDLINE, pre-MEDLINE, MEDLINE Daily Update, and the Cochrane Controlled Trials Register were searched to identify human studies that related variables associated with atherosclerosis to periodontal disease. Searches were made for papers published from 1966 through March 2002. INCLUSION CRITERIA Published randomized controlled clinical trials (RCTs), longitudinal, cohort, and case-control studies were included. Study participants included those with atherosclerosis, myocardial infarction (MI), stroke, or PVD. Oral conditions included periodontal disease. EXCLUSION CRITERIA Only studies on humans were included. DATA COLLECTION AND ANALYSIS Because the studies used different oral assessment measures, it was not possible to perform a meta-analysis of the data reported. Weighted mean differences, relative risks, or odds ratios were compared for cohort studies. MAIN RESULTS 1. Of the initial 1,526 studies identified, 31 (including 8 case-control and 18 cross-sectional reports) were included in the analysis. Taken together, most of the literature supports a modest association between periodontal disease and atherosclerosis. However, data reported in several studies do not show this association. 2. The absence of a standard definition and measures for periodontal disease complicates interpretation of results, as do potential confounding risk factors common to both conditions. REVIEWERS' CONCLUSIONS 1. Periodontal disease may be modestly associated with atherosclerosis, MI, and CVD. 2. Additional large-scale longitudinal epidemiologic and intervention studies are necessary to validate this association and to determine causality.