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BRUSSELS/GENEVA: There is strong epidemiological evidence that periodontitis causes an increased risk for future atherosclerotic cardiovascular disease.
Patients with periodontitis should be advised that they have a higher risk of suffering cardiovascular diseases – including myocardial infarction and stroke – and that they should actively manage risk factors (such as smoking, lack of exercise, excess weight, blood pressure, and a diet high in saturated fats and refined sugars).
On top of that, patients who have both periodontitis and cardiovascular disease should be informed that they may be at higher risk of suffering subsequent cardiovascular complications and that they should therefore stick to recommended dental regimes of prevention, treatment, and maintenance.
These are among the highlights of the consensus report from an expert workshop on the links between periodontal and cardiovascular diseases, organised jointly by the European Federation of Periodontology (EFP) and the World Heart Federation (WHF).
The consensus article, published on 3 February 2020 in the two federations’ respective scientific publications – the Journal of Clinical Periodontology and Global Heart – is the fruit of the Perio-Cardio Workshop, held in Madrid in February 2019. This workshop brought together more than 20 experts from the two organisations to consider the latest evidence about the associations between periodontal and cardiovascular diseases and to draft a series of recommendations on prevention and therapy.
Both cardiovascular disease and periodontitis are chronic non-communicable diseases. Periodontitis has an overall global prevalence of 45-50% and its severe form affects 11.2% of the world’s population, making it the sixth most common human disease. Cardiovascular disease is responsible for 17.9 million deaths per year worldwide (one third of all deaths), including 3.9 million in Europe (45% of all deaths), with ischaemic heart disease, stroke, and hypertension leading to heart failure the main causes. Although mortality rates are falling, the absolute numbers have increased over the last 25 years because of an increasingly ageing population.
The percentage of deaths from cardiovascular disease is higher in Europe not only because of an ageing population but also because of risk factors associated with a “Western” lifestyle, such as poor diet (high in saturated fats, salt, and refined sugar), obesity, smoking, and lack of exercise. Some of these are also lifestyle risk factors for periodontal disease. In addition, the report highlights shared genetic risk factors for the two diseases.
The report states that severe periodontitis is independently and significantly associated with cardiovascular disease from all causes and with cardiovascular mortality in various populations. Proposed mechanisms to explain this association include bacteraemia and the associated systemic inflammatory sequelae, including elevations in C-reactive protein and oxidative stress.
The Perio-Cardio Workshop produced a series of recommendations for oral-health professionals to use in the dental practice with people with cardiovascular disease, for physicians and other medics to use in cardiology practice, and for patients with cardiovascular disease. The workshop also reviewed the potential risk and complications of periodontal therapy in patients who are on anti-thrombotic medication and the report provides detailed recommendations in this area.
The consensus report was based on four technical papers that systematically reviewed the evidence for epidemiological associations between periodontitis and incident CVD, mechanisms of biological plausibility relating to periodontal bacteria and systemic inflammation (two reviews), and periodontal intervention studies.
The Perio-Cardio Workshop built on and updated the pioneering work of the IX European Workshop on Periodontology, a joint workshop of the EFP and the American Academy of Periodontology that was held in 2012, which explored the links between periodontitis and systemic conditions including cardiovascular diseases.
“This workshop was a great opportunity for both cardiology and periodontal communities to review the scientific evidence behind these associations in a rigorous and unbiased manner,” said Professor Mariano Sanz, Co-chair of the Perio-Cardio Workshop, Professor of periodontology at the Complutense University of Madrid (Spain), and Lead Author of the consensus report. “In this way, the health implications and recommendations from this consensus report should serve all stakeholders in implementing actions aimed at the prevention of both cardiovascular and periodontal diseases.”
Professor Pablo Perel, Senior Science Adviser of the World Heart Federation, Deputy Editor of Global Heart, and Professor of clinical epidemiology at the Centre for Global Chronic Conditions, London School of Hygiene & Tropical Medicine (UK), commented:
“Cardiovascular disease is the leading cause of death and disability worldwide. Now that we are aware of the association between periodontitis and coronary heart disease, we need to emphasize risk factors such as smoking and poor diet. People with periodontitis should be informed about cardiovascular risk. We need to move beyond disease silos and have a “person-centred” approach, which is why we at WHF are proud to have joined forces with the EFP on this important issue.”
The EFP will now take the findings of the Perio-Cardio Workshop, as expressed in the consensus report, to create an outreach campaign on periodontal and cardiovascular health which will provide specific materials to dentists, physicians, and patients who visit both dental and medical practices.
This campaign, like the Perio-Cardio Workshop, will be sponsored by DENTAID, which is an EFP partner. It is due to be launched in April 2020.
Note: The full report “Periodontitis and cardiovascular disease: Consensus report is published in the Journal of Clinical Periodontology, Volume 47. DOI: https://doi.org/10.1111/jcpe.13189 and Global Heart, Volume 15, Issue 1. DOI: http://doi.org/10.5334/gh.400.
About the EFP
The European Federation of Periodontology (EFP) is a non-profit organisation dedicated to promoting awareness of periodontal science and the importance of gum health. Its guiding vision is “periodontal health for a better life.”
Founded in 1991, the EFP is a federation of 37 national periodontal societies that represents more than 16,000 periodontists, dentists, researchers and oral-health professionals in Europe and around the world. It pursues evidence-based science and the general interest, promoting events and campaigns aimed at both professionals and the public.
Through events such as the triennial EuroPerio congress, its scientific publication the Journal of Clinical Periodontology, its accredited programme for postgraduate education, and the annual Gum Health Day awareness initiative, the EFP is at the forefront of promoting periodontal science and gum health.
The World Heart Federation is the principal representative body for the global cardiovascular community, representing more than 200 heart foundations, scientific societies, civil society, and patient organisations from over 100 countries.
Together with our Members, we are working to end needless deaths and build global commitment for improved cardiovascular health at the global, regional, national, and community levels.
We believe in a world where heart health for everyone is a fundamental human right and a crucial element of global health justice.
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