Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis

Bodanese, Luiz Carlos; Louzeiro, Gabriel Campos; Magnus, Gabriela Agne; Baptista, Ângela Hamann; Salum, Fernanda Gonçalves; Mattiello, Rita

doi:10.36660/ijcs.20200055

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International Journal of Cardiovascular Sciences

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VIEWPOINT • Int J Cardiovasc Sci 34 (5 Supl 1) • 2021 • https://doi.org/10.36660/ijcs.20200055 copy

Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The association between periodontitis and myocardial infarction remains unclear in the literature. Few studies have addressed periodontitis exposure as a predisposing factor for the development of myocardial infarction. Therefore, the present systematic review aims to analyze the association between periodontitis and myocardial infarction. This meta-analysis systematically searched MEDLINE, EMBASE, The Cochrane Controlled Trials Register, SCIELO, LILACS, CINAHL, Scopus, Web of Science and grey literature for studies estimating the association between periodontitis and myocardial infarction. Quality of evidence was assessed for all studies. The meta-analysis was conducted using random-effects models. Four of the six studies selected were included in the meta-analysis, including 1,035,703 subjects. The association between periodontitis and myocardial infarction was: RR: 5.99 (95% CI: 1.17-30.68), but with high heterogeneity (I² = 100%; p <0.01). The results including only the highest quality articles, was lower: RR: 2.62 (95% CI: 1.47-4.70 3.83), but with lower heterogeneity (I² = 85.5%; p < 0.01).The present systematic review with meta-analysis showed an association between periodontitis and acute myocardial infarction, but with a high level of heterogeneity.

Cardiovascular Diseases/mortality; Periodontitis/complications; Pulpitis, Myocardial Infarction/complications; Atherosclerosis/complications. Lipoproteins/analysis; Atherosclerosis/complications; Inflammation; Meta-Analysis

Author, year	population	n	Age (Years)	Gender	Design and observation time	Definition of mi	Definition of periodontitis
Arbes et al., (1999) ¹⁰	NHANES III* data of United States population sample	5564	≥40	2,757 men 2,807 women	Cross-sectional study	Self-reported heart attack	Clinical attachment loss ≥ 3mm
HOLMLUNet al., (2006) ^17-18	Patients from the Department of Periodontology, Gävle County Hospital	4.254	20 – 70	1,866 men 2,388 women	Cross-sectional study	Self-reported heart attack	Bone loss >2mm
NOGUCHI ET AL., (2014) ¹⁴	Employees of a financial company in Japan	3081	36 – 59	Only men	Prospective cohort between 2004 - 2009	Patients report that they were undergoing myocardial infarction treatment	Self-administered questionnaire produced by the authors.
LEE et al., (2015) ¹⁵	Random sample (2% of total) of South Korean population covered by National Health Insurance	1.025.340	1-79	513,258 men 512,082 women	Retrospective cohort between 2002 a 2013	Records of the 6th ed. Korean Classification of Diseases (KCD-6): Code not specified	Records of the 6th ed. Korean Classification of Diseases (KCD-6): K052 – K056
HANSEN et al., (2016) ¹⁶	Sample of the Danish population from the National Patient Registry	100.694	≥18	57,421 men 43,273 women	Prospective cohort between 1997- 2011	International Classification of Diseases (ICD-10) Records: Codes I21-I22	International Classification of Diseases (ICD-08) Records: Code 523.49 and 523.49 International Classification of Diseases (ICD-10) Records: Code K05.2 - 05.3.
HOLMLUNet al. ( 2017) ^17-18	Patients from the Department of Periodontology, Gävle County Hospital	8.999	20-85	3,870 men 5,129 women	Prospective cohort between 1979 - 2013	International Classification of Disease Records: 421 (ICD-8 and ICD-9) and I21 (ICD-10)	Probing depth ≥ 4mm

Author, year	Severity		Control	Outcome (N. cases/N. controls)	HR, ODDS, RR, OR (IC 95%)	Variable
ARBES S.J, (1999)	Percent of sites with periodontal attachment loss of ≥3 mm:	>0-33	No periodontitis	88/5.564	ODDS 1,38 (0,75-2,54)	Percent of sites with periodontal attachment loss ≥3; age; sex; race; smoking status; history of diabetes; history of high blood pressure; body mass indices; poverty index; serum cholesterol.
		>33-67		73/5.564	ODDS 2,28 (1,18-4,39)
		>67-100		55/5.564	ODDS 2,28 (1,18-4,39)
HOLMLUND A, (2006)	Periodontal bone loss		No periodontal bone loss (<2mm)	Not informed	ODDS 2,69 (1,12-6,46)	Age, gender and smoking.
NOGUCHI S, (2014)	With periodontist or without periodontitis		No periodontitis	9/3081	OR 2,26 (0,84-6,02)	Age; BMI; current smoking; hypertension; diabetes; dyslipidemia; family history of heart disease.
LEE J.H, (2015)	With periodontist or without periodontitis		No periodontal disease	8.179/1.025.340	ODDS 0,98 (0,86-1,12)	Sociodemographic/economic status and comorbidities.
HANSEN G.M, (2016)	With periodontist or without periodontitis		No periodontitis	Not informed	IRR 1,16 (1,04- 1,30)	Age; sex; smoking; comorbidities; medication and socioeconomic status.
HOLMLUND A, (2017)	Numbers of surfaces with pocket depth > 4mm		No periodontal disease	570/8.999	IRR 1,13 (0,98-1,30)	Age; sex; education level and smoking.

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[1] Mailing Address: Luiz Carlos Bodanese: Av. Ipiranga, 6690, cj. 402. Postal Code: 90610-000, Porto Alegre, RS – Brazil. E-mail: lcbodanese@pucrs.br