Several studies have shown periodontal disease to be linked to arterial inflammation. The American Heart Association, after reviewing numerous studies concluded there is “level A” evidence (superb studies in multiple populations) that periodontal disease is independently (after adjusting for a multitude of other known risk factors) associated with arterial disease. While a cause-and-effect relationship has not yet been proven, researchers think that inflammation caused by periodontal disease is the most likely cause. Periodontal disease can exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if this is necessary.

Additional studies indicate there is a relationship between periodontal disease and stroke. Studies have not only linked periodontal disease to Cardiovascular Heart Disease (CVD) and stroke, but they have also indicated dramatically increased risk of having CVD and/or stroke if periodontitis is present. A 1999 study that adjusted for other risk factors demonstrated positive correlation between periodontitis and coronary heart disease. In this 1999 study, those with extensive periodontal pockets had a C-reactive Protein (CRP) level 7 times higher, than those without periodontal disease. Their CRP levels were at levels significantly associated with risk of CVD and stroke. A 1993 study of 9,760 adults who were followed over a 14-year period found those who had periodontal disease were 25% more likely to develop coronary artery disease compared to those with minimal levels of periodontal disease. Males with periodontitis under the age of 50 were 72% more likely to develop coronary artery disease versus their counterparts. A 1996 study reported a 50% increased risk of fatal CVD for patients age 30-40. A 1997 study indicated a 250% increased risk of stroke.

Note: Tobacco smoking and secondhand smoke increase the risk of CVD and other systemic diseases. Worldwide, tobacco smoking was one of the top three leading risk factors for disease and contributed to an estimated 6.2 million deaths in 2010. Sixteen percent of students grades 9-12 reported being current smokers. Among adults, 20 percent of men and 16 percent of women are smokers.

Statistics You Should Take to Heart

Cardiovascular Heart Disease (CVD) is the leading cause of death in the United States. An estimated 30 percent of deaths across the globe occur due to heart disease. According to the Global Burden of Disease Project, it is projected that by 2030, nearly 23.6 million people will die from heart disease and related conditions. Population studies and clinical research reveal that the majority of these deaths can be prevented by simple lifestyle changes like exercise and food habits.

According to the American Heart Association, six million CVD deaths are recorded globally per year. One-third of those are individuals less than 70 years old. Fifty percent of recurrent CVD events are fatal. Reported statistics underline the gravity of CVD.

Cardiovascular Disease Overall
• In 2008, cardiovascular deaths represented 30 percent of all global deaths, with 80 percent of those deaths taking place in low-income and middle-income countries.
• Nearly 787,000 people in the U.S. died from heart disease, stroke and other cardiovascular diseases in 2011. That’s about one out of every three deaths in America.
• About 2,150 Americans die each day from these diseases, one every 40 seconds.
• Cardiovascular diseases claim more lives than all forms of cancer combined.
• About 85.6 million Americans are living with some form of cardiovascular disease or the after-effects of stroke.
• Direct and indirect costs of cardiovascular diseases and stroke total more than $320.1 billion. That includes health expenditures and lost productivity.
• Nearly half of all African-American adults have some form of cardiovascular disease—48 percent of women and 46 percent of men.
• Heart disease is the number one cause of death in the world and the leading cause of death in the United States, killing over 375,000 Americans a year.
• Heart disease is the number one killer of women, taking more lives than all forms of cancer combined.
• Over 39,000 African-Americans died from heart disease in 2011.

Cardiac Arrest
• In 2011, about 326,200 people experienced out-of-hospital cardiac arrests in the United States. Of those treated by emergency medical services, 10.6 percent survived. Of the 19,300 bystander-witnessed out-of-hospital cardiac arrests in 2011, 31.4 percent survived.
• Each year, about 209,000 people have a cardiac arrest while in the hospital.

• Stroke is the number four cause of death in the United States, killing nearly 129,000 people a year.
• Someone in the U.S. has a stroke about once every 40 seconds. That is equivalent to 795,000 people every year.
• Stroke kills someone in the U.S. about once every four minutes. That’s one in every 20 deaths per annum.
• Stroke is a leading cause of disability.

High Blood Pressure
• About 80 million U.S. adults have high blood pressure. That’s about 33 percent. About 77 percent of those are using antihypertensive medication, but only 54 of those have their condition controlled.
• Nearly half of people with high blood pressure (46 percent) do not have it under control.
• Approximately 69 percent of people who have a first heart attack, 77 percent of people who have a first stroke and 74 percent who have congestive heart failure have blood pressure higher than 140/90 mm Hg.
• Hypertension is projected to increase about 8 percent between 2013 and 2030.
• Rates of high blood pressure among African-Americans are among the highest of any population in the world. Here is the U.S. breakdown by race and gender.
 46 percent of African-American women
 45 percent of African-American men
 33 percent of white men
 30 percent of white women
 30 percent of Hispanic men
 30 percent of Hispanic women
• In 2000, it was estimated that 972 million adults worldwide had hypertension.

How to Help Prevent CVD and Stroke
Talk to your doctor and be aware of the risk factors that can lead to CVD and stroke. Be sure to take preventive measures that will reduce the risk, including changes in diet, cessation of smoking, regular exercise, weight control, regular medical exams, and compliance with prescribed medication for high blood pressure, as well as other cardiovascular conditions. Preventive measures most definitely include good oral hygiene at home, regular teeth cleaning, and check ups for periodontal disease. If gingivitis or periodontitis is present, do not delay treatment.

Research Referenced

 Fifer KM, Qadir S, et al. Positron emission tomography measurement of periodontal 18F-Fluorodeoxyglucose uptake is associated with histologically determined carotid plaque inflammation. J Am Coll Cardiology, 2011(57):971-6.

 Lockhart PB, Bolger AF, et al. Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association?: a scientific statement from the American Heart Association. Circulation, 2012(125)2520-44.

 Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol. 1996(67):1123–37.

 Genco RJ, Wu TJ, Grossi S. Periodontal microflora related to the risk for myocardial infarction:a case control study. J Dent Res 1999;78:457.

 DeStefano F, et al. Dental disease and risk of coronary heart disease and mortality. Br Med J 1993;306:688-691.

 Beck J, et al. Periodontal disease and cardiovascular disease. J Periodontol, 1996(67: Suppl 10):1123-1137.