The associations of periodontal disease with atrial fibrillation and heart failure: observations from a large prospective UK cohort.
J Lin, G Lip, A Shantsila, E Shantsila, M RasionAbstract
Backgrounds
Periodontal disease has been implicated in the development of cardiovascular diseases through systemic inflammatory pathways. This study aims to investigate associations of periodontal disease with atrial fibrillation (AF) and heart failure (HF) risks in a large prospective UK cohort.
Methods
We included 485,349 UK Biobank participants free of AF and HF at baseline. Periodontal status was assessed using self-reported oral health indicators and categorized by severity (no periodontitis, painful gums, loose teeth). Incident AF and HF were identified through linked hospital admission, primary care, and death registry records. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) with sequential adjustment for demographic, socioeconomic, lifestyle, and clinical covariates.
Results
Over a median follow-up of 12.7 years (IQR 9.8-14.9), 28,581 AF and 13,755 HF events occurred. In fully adjusted models, periodontitis was not independently associated with AF when analyzed as a binary exposure (HR 1.01, 95% CI 0.97–1.06). In contrast, periodontitis was independently associated with incident HF (HR 1.16, 95% CI 1.10–1.23).When stratified by severity, painful gums were modestly associated with AF (HR 1.10, 95% CI 1.02–1.18), whereas loose teeth were not. In contrast, periodontitis was independently associated with incident HF after full adjustment (HR 1.16, 95% CI 1.10–1.23). Both painful gums (HR 1.18, 95% CI 1.07–1.30) and loose teeth (HR 1.15, 95% CI 1.08–1.23) were consistently associated with increased HF risk. The association between periodontitis and HF was stronger in women than in men (p for interaction = 0.02).
Conclusions
Periodontal disease was independently associated with an increased risk of HF but not AF overall, suggesting a close link between periodontal health and HF risk.Association between Periodontitis and AF/HF