Periodontal and cardiovascular diseases have an established association. A causal link is still being explored. Nonetheless, the two diseases are prevalent and a public health concern.
A large nationwide cohort study aiming to “evaluate the association of dental diseases and oral hygiene care with the incidence of heart failure among patients with type 2 diabetes” was published in the Journal of the American Heart Association in 2023.1
In case you missed it, here is what the authors found.
The Study
This study used retrospective data from the Korean NHIS, a national health insurance system providing extensive medical data on nearly the entire South Korean population. Researchers initially identified 3,913,183 individuals with type 2 diabetes who underwent health and oral health screenings in 2008.1
After excluding those with missing data, individuals under 40, those without type 2 diabetes, and those previously diagnosed with heart failure, 173,927 participants (125,948 men and 47,979 women) were included. These individuals were followed until December 31, 2017.1
The Results
The study found that a higher number of missing teeth was associated with an elevated risk of heart failure in patients with type 2 diabetes. Additionally, the presence of multiple dental diseases further increased the risk.1
On the other hand, regular oral hygiene practices, such as professional hygiene treatment and toothbrushing, were associated with a reduced risk of heart failure, with a combination of these practices providing even greater protection.1
The heightened heart failure risk from poor oral health and dental diseases was lessened with improved oral hygiene. These findings suggest that dental diseases could be independent risk factors for heart failure in patients with type 2 diabetes, while good oral hygiene may offer protection against heart failure.1
Several pathological mechanisms underlying dental diseases may contribute to atherosclerosis, cardiovascular disease, and heart failure. First, dental diseases trigger systemic inflammation, which leads to the release of C-reactive protein and interleukin-6, ultimately promoting atherosclerosis and cardiovascular disease.1
Research has shown that individuals with more significant tooth loss tend to have higher C-reactive protein levels. Additionally, the human microbiota plays a role in heart failure development. Certain bacteria in the oral microbiome produce trimethylamine-N-oxide (TMAO), a compound that significantly increases the risk of atherosclerosis and heart failure.1
Some bacterial toxins in the mouth, including those from Fusobacterium and Lachnospiraceae, are linked to higher cholesterol levels, contributing to the formation of atherosclerotic plaques. However, good oral hygiene practices may reduce chronic inflammation and positively influence the oral microbiome.1
While this study offers valuable insights, it has several limitations. First, the NHIS database relies on physician-assigned diagnostic codes, which could sometimes lead to underdiagnosis or overdiagnosis.1
Second, the study’s observational nature limits the ability to conclude causality, although efforts were made to minimize reverse causality by excluding individuals with a prior heart failure diagnosis.1
Third, the authors could not account for inflammation or microbial factors affecting heart failure risk, as these were not included in the NHIS data. Additionally, the database lacked echocardiography results, including ejection fraction, preventing an analysis of different heart failure types.1
Fourth, oral hygiene care was self-reported via questionnaire, introducing potential recall bias. Lastly, the study was conducted in a South Korean population, so the findings may not be generalizable to other regions or ethnic groups.1
While prior studies have explored the association between oral health and cardiovascular disease in the general population, this study specifically focused on how various oral health factors combined to influence heart failure risk in individuals with type 2 diabetes, who are more susceptible to both dental disease and cardiovascular issues.1
Given that heart failure may be an early indicator of cardiovascular disease in these patients and that hospitalization rates for heart failure are higher among those with type 2 diabetes, the findings suggest that managing dental health and maintaining good oral hygiene could help lower the risk of heart failure in this vulnerable population.1
In Conclusion
The study found an association between dental diseases, poor oral hygiene, and heart failure occurrence in South Korean patients with type 2 diabetes. Patients with both dental diseases and poor oral health saw an even higher heart failure risk, while those practicing better oral hygiene experienced a risk reduction.1
Notably, even with dental diseases, maintaining good oral hygiene helped lower the risk of heart failure. These findings suggest that dental health and oral care are significant factors in the development of heart failure in patients with type 2 diabetes. Enhancing oral health through proper dental care and hygiene practices may play a role in preventing heart failure in this population.1
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Reference
1. Huh, Y., Yoo, J.E., Park, S.H., et al. Association of Dental Diseases and Oral Hygiene Care With the Risk of Heart Failure in Patients With Type 2 Diabetes: A Nationwide Cohort Study. J Am Heart Assoc. 2023; 12(16): e029207. https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/37548156/
