AHA: No Evidence That Gum Disease Causes CHD

April 19, 2012

April 18, 2012 (Charlotte, North Carolina) — A new scientific statement from the American Heart Association (AHA) pours cold water on the idea that periodontal disease contributes to atherosclerosis, heart disease, or stroke [1].

The statement, in a paper published online in Circulation on April 18, 2012, says that although observational studies support an association between periodontal disease and atherosclerotic vascular disease independent of known confounders, they do not support a causative relationship.

The American Dental Association Council on Scientific Affairs says it agrees with the conclusions of the AHA statement.

Lead author of the statement, Dr Peter Lockhart (Carolinas Medical Center, Charlotte, NC), commented to heartwire : "We were aware of concerns that have been reported in the lay press about the idea that gum disease can lead to heart disease, and there was an overwhelming consensus that the AHA should look into it to assess whether the science supported such concerns."

Not worth stressing out about

He added: "After extensive review of all the literature in this field, we were not able to find any real scientific evidence that periodontal disease causes atherosclerosis or that treating periodontal disease has any long-term effect on atherosclerosis or heart disease. Although we also haven't proved that the link is not causative, it would seem that if it were causative, it would be a small relationship. And it does not appear to be worth creating too much stress about it.

"Our message is that while good oral hygiene is obviously still important, patients should not be distracted by periodontal disease in trying to lower their rates of heart attack and stroke. Rather, they should focus on the well-known causes of heart disease such as hypertension, obesity, and high cholesterol. Reducing these things can make a real difference."

Lockhart said that while periodontal disease does increase the likelihood of bacteria in the bloodstream, this is not necessarily influencing atherosclerosis.

In the paper, the authors note that the question of whether a clinically significant association exists between periodontal disease and heart disease has tremendous importance, given the potential impact on public health if therapeutic opportunities could be identified. "The lack of consensus among experts and the confusion among healthcare providers and the public all suggest the need for a systematic review of the topic."

The authors conclude that the association between periodontal disease and atherosclerosis comes mostly from observational studies and therefore does not demonstrate that periodontal disease is a cause of atherosclerosis, "nor does it confirm the contention that therapeutic periodontal interventions prevent heart disease or stroke or modify the clinical course of atherosclerotic vascular disease."

They add: "Although a contribution of periodontal disease to atherosclerotic vascular disease is biologically plausible, periodontal and cardiovascular diseases share multiple risk factors that are prevalent and powerful promoters of disease, including tobacco use, diabetes mellitus, and age." And "although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent atherosclerotic vascular disease or modify its outcomes."

They further note that "the effects of periodontal-disease therapy on specific inflammatory markers are not consistent across studies, their sustainability over time has not been established convincingly, and determinants of variability in these responses remain poorly understood."

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