NMU 283 – Periodontal Disease Increases Risk of Heart Failure

Nutrition/Natural Medicine Update No 283 (April 11, 2023)

with Dr. James Meschino

Topic: Periodontal Disease Increases Risk of Heart Failure

Source: Journal of the American College of Cardiology (2022)

Although largely underappreciated, periodontal disease is emerging as a significant risk factor for the development of heart failure. To this end, the Journal of the American College of Cardiology published the results of a large research study in 2022 that showed a strong correlation between periodontal disease and risk of heart failure. The researchers followed almost 7,000 participants (6,707), average age 63 years old from the year 1996 to 2018, as part of the Atherosclerosis Risk In Communities study (ARIC study).  As the researchers point out, previous studies have shown a strong correlation between periodontal disease and risk of coronary artery disease, ischemic stroke, adverse cardiovascular outcomes and/or diabetes. But the 2022 study showed convincing evidence that heart failure risk also increases substantially in the presence of periodontal disease. As the researchers commented, heart failure is already increasing at an alarming rate in our society due to the aging population coupled with the rising incidence in diabetes, obesity, and metabolic syndrome.  In the United States, it is estimated that >8 million people will be living with heart failure by the year 2030. Making matters worse is the fact that medical treatment for heart failure has not substantially improved in many years, whereby 50% of heart failure patients still die within the first five years after diagnosis.

So, where does periodontal disease fit into the story?

The 2022 study showed that not only do subjects with periodontal disease have a higher risk of developing heart failure, but they also have higher blood levels of the key blood indicator of heart failure, which is the NT-proBNP blood marker. Periodontal disease (periodontitis) is a condition characterized by destruction of tooth-supporting tissues and subgingival (gum) microbial dysbiosis. Previous studies have shown a link between gut dysbiosis and leaky gut problems and risk of heart failure. Dysbiosis means that you have too many unfriendly (or harmful) bacteria in your gut and too few friendly (health-promoting) bacteria in your gut. A leaky gut allows more bacterial endotoxins to enter the body and trigger an inflammatory response that can damage the heart and vascular system.  But the 2022 study showed for the first time that dysbiosis in the oral cavity, which is the key finding and cause of periodontal disease, also increases inflammatory markers in the bloodstream that lead to heart failure. In fact, other studies have shown that by successfully treating periodontal disease and reversing oral dysbiosis, markers for inflammation in the bloodstream decrease significantly (i.e., C-reactive protein – CRP).

Certain inflammatory markers are shown to be elevated in heart failure, including interleukin (IL)-6, tumor necrosis factor (TNF)-α, and CRP. The Framingham Heart Study is one such study that showed a 5-year risk of developing heart failure increased by 60-68% as inflammatory markers in the blood (TNF and IL-6) became more elevated. These inflammatory products (Il-6, TNF, CRP) damage the heart by causing death of heart muscle cells (apoptosis), promote heart hypertrophy, fibrosis and stiffness and they alter the ability of heart muscles to access the calcium they require for normal heart pumping action. The bottom line is that good oral hygiene is an often-overlooked factor in the prevention of cardiovascular disease, including heart failure, as the 2022 ARIC study has shown. Regular dental check-ups and regular visits to your dental hygienist for teeth cleaning, as well as daily at home dental care should be a priority over your lifetime, as one more step to maintain cardiovascular health.

Keep in mind that supplementation with CoQ10 and Hawthorn after the age of 40-45 also helps your heart maintain more optimal pumping ability, helping to prevent and co-manage heart failure problems, according to many studies. CoQ10 and Hawthorn supplementation, like periodontal disease prevention and management, are also often-overlooked strategies that can help to keep your heart strong and functional.

I have included the reference for the 2022 ARIC study in the text below.

Reference:

Mokinsky R.L. et al. Periodontal status, C-reactive protein, NT-proBNP, and incident heart failure. JACC Heart Fail. 2022;10(10):731-741.  https://www.medscape.com/viewarticle/989492?ecd=wnl_recnlnew3_ous_230327_MSCPEDIT_&uac=342474MN&impID=5282701

Eat Smart, Live Well, Look Great,

Dr. Meschino