Coronary artery disease remains a leading cause of morbidity and mortality worldwide (Benjamin et al., 2019). While traditional risk factors such as hypertension, diabetes, and smoking are well-documented, emerging evidence suggests that poor oral health, particularly periodontal disease, is a significant yet often overlooked contributor to cardiovascular risk (Lockhart et al., 2012). American Heart Month serves as an opportunity to underscore the importance of oral health in preventing systemic diseases, particularly CAD.

Biological Mechanisms Linking Periodontal Disease and CAD Several biological mechanisms have been proposed to explain the association between periodontal disease and CAD:

1. Inflammation: Periodontal disease is characterized by chronic inflammation, which can lead to systemic inflammatory responses and contribute to atherosclerosis (Tonetti et al., 2013).
2. Bacterial Translocation: Oral bacteria such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans have been identified in atherosclerotic plaques, suggesting that bacteremia from periodontal infections may contribute to endothelial dysfunction (Kozarov et al., 2005).
3. Endothelial Dysfunction: Periodontal pathogens can induce endothelial dysfunction through increased oxidative stress and reduced nitric oxide bioavailability, a key factor in the development of CAD (Desvarieux et al., 2005).

Clinical Evidence Supporting the Association

Epidemiological studies have demonstrated a significant correlation between periodontal disease and increased cardiovascular risk. A meta-analysis by Humphrey et al. (2008) found that individuals with periodontal disease had a 24% higher risk of developing CAD. Similarly, a longitudinal study by DeStefano et al. (1993) reported that men with periodontitis were at a 25% increased risk of myocardial infarction compared to those without periodontal disease.

Implications for Clinical Practice

Given the evidence supporting the oral-systemic link, it is crucial for healthcare providers to integrate oral health assessments into cardiovascular risk evaluations. Dentists and cardiologists should collaborate to screen for periodontal disease in patients with CAD and vice versa. Preventive strategies, including routine dental cleanings, improved oral hygiene, and patient education, should be emphasized as part of comprehensive cardiovascular care.

Conclusion

The correlation between poor oral health and CAD underscores the importance of an interdisciplinary approach to healthcare. Future research should continue to explore the causal mechanisms and potential interventions to mitigate cardiovascular risk through improved oral health. During American Heart Month, healthcare professionals should advocate for greater awareness of this critical health connection.

References

Benjamin, E. J., Muntner, P., Alonso, A., et al. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation, 139(10), e56-e528. https://doi.org/10.1161/CIR.0000000000000659

DeStefano, F., Anda, R. F., Kahn, H. S., Williamson, D. F., & Russell, C. M. (1993). Dental disease and risk of coronary heart disease and mortality. BMJ, 306(6879), 688-691. https://doi.org/10.1136/bmj.306.6879.688

Desvarieux, M., Demmer, R. T., Jacobs, D. R., et al. (2005). Periodontal bacteria and hypertension: The oral infections and vascular disease epidemiology study (INVEST). Hypertension, 46(5), 1119-1125. https://doi.org/10.1097/HJH.0b013e328338cd36

Humphrey, L. L., Fu, R., Buckley, D. I., Freeman, M., & Helfand, M. (2008). Periodontal disease and coronary heart disease incidence: A systematic review and meta-analysis. Journal of General Internal Medicine, 23(12), 2079-2086. https://doi.org/10.1007/s11606-008-0787-6

Kozarov, E. V., Dorn, B. R., Shelburne, C. E., Dunn, W. A., & Progulske-Fox, A. (2005). Human atherosclerotic plaques contain viable Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans. Arteriosclerosis, Thrombosis, and Vascular Biology, 25(3), e17-e18. https://doi.org/10.1161/01.ATV.0000155018.67835.1a

Lockhart, P. B., Bolger, A. F., Papapanou, P. N., et al. (2012). Periodontal disease and atherosclerotic vascular disease: Does the evidence support an independent association? A scientific statement from the American Heart Association. Circulation, 125(20), 2520-2544. https://doi.org/10.1161/CIR.0b013e31825719f3

Tonetti, M. S., Van Dyke, T. E., & Working Group 1 of the Joint EFP/AAP Workshop. (2013). Periodontitis and atherosclerotic cardiovascular disease: Consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. Journal of Clinical Periodontology, 40(Suppl 14), S24-S29. https://doi.org/10.1902/jop.2013.1340019