Periodontal Status, C-Reactive Protein, NT-proBNP, and Incident Heart Failure

BACKGROUND Periodontal disease (PD), resulting from inflammatory host response to dysbiotic subgingival microbiota, has been linked to cardiovascular disease; however, its relationship to heart failure (HF) and its subtypes (heart failure with reduced ejection fraction [HFrEF] and heart failure with preserved ejection fraction [HFpEF]) is unexplored.OBJECTIVES The authors hypothesize that the presence of PD is associated with increased risk of incident HF, HFpEF, and HFrEF. METHODS A total of 6,707 participants (mean age 63 & PLUSMN; 6 years) of the ARIC (Atherosclerosis Risk In Communities) study with full-mouth periodontal examination at visit 4 (1996-1998) and longitudinal follow-up for any incident HF (visit 4 to 2018), or incident HFpEF and HFrEF (2005-2018) were included. Periodontal status was classified as follows: healthy, PD (as per Periodontal Profile Classification [PPC]), or edentulous. Multivariable-adjusted Cox proportional hazards models were used to calculate HRs and 95% CIs for the association between PPC levels and incident HF, HFpEF, or HFrEF. Additionally, biomarkers of inflammation (C-reactive protein [CRP]) and congestion (N-terminal brain natri-uretic peptide [NT-proBNP]) were assessed.RESULTS In total, 1,178 incident HF cases occurred (350 HFpEF, 319 HFrEF, and 509 HF of unknown type) over a median of 13 years. Of these cases, 59% had PD, whereas 18% were edentulous. PD was associated with an increased risk for HFpEF (HR: 1.35 [95% CI: 0.98-1.86]) and significantly increased risk for HFrEF (HR: 1.69 [95% CI: 1.18-2.43]), as was edentulism: HFpEF (HR: 2.00 [95% CI: 1.37-2.93]), HFrEF (HR: 2.19 [95% CI: 1.43-3.36]). Edentulism was associated with unfavorable change in CRP and NT-proBNP, whereas PD was associated only with CRP.CONCLUSIONS Periodontal status was associated with incident HF, HFpEF, and HFrEF, as well as unfavorable changes in CRP and NT-proBNP. (J Am Coll Cardiol HF 2022;10:731-741) (c) 2022 by the American College of Cardiology Foundation.

Automated summary

Periodontal disease is associated with an increased risk of incident heart failure, both with reduced and preserved ejection fraction, while being completely edentulous is also linked to a higher risk. Additionally, periodontal disease is associated with unfavorable changes in biomarkers of inflammation and congestion.