Abstract 245: Dose‐dependent relationship between periodontal disease and ischemic stroke

Introduction The link between periodontal disease and cerebrovascular disease was reported in various studies, with several mechanistic underpinnings. To determine the predictive value of periodontal disease for cerebrovascular diseases, we aimed to investigate the quantitative association between various degrees of periodontal disease and subtypes of cerebrovascular disease. Methods Using Meta‐analyses Of Observational Studies in Epidemiology and PRISMA guidelines, we searched 6 databases through May 2024 for cohort and case‐control studies evaluating the relationship between periodontal disease and ischemic or hemorrhagic stroke. Studies were included if they reported risk ratios (RRs) and 95% confidence intervals or raw patient‐level data (that were computed into RRs). Unadjusted and vascular risk‐factor adjusted ORs were pooled into meta‐analysis using DerSimonian Laird random effects model. Study quality, publication and dissemination biases were assessed and integrated in the analyses (RevMan software). Results 12 prospective studies encompassing 31, 324 patients were eligible for the qualitative and quantitative syntheses. After vascular risk‐factor adjustment, any degree of periodontitis was associated with an increased risk of ischemic stroke (RR, 2.24, 95% CI [1.67‐2.98], p<0.001, I2=10). Subgroup analysis including subjects with moderate or severe periodontitis showed a higher risk of ischemic stroke (RR, 3.01, 95% CI [1.01‐4.05], p<0.001). Associations remained significant after adjustments for quality and publication biases. Heterogeneity was low (I2<20%) for all syntheses. The reported mechanisms were cardioembolism and thromboembolism. The risk of hemorrhagic stroke could not be synthesized due to limited data. Conclusions A dose‐dependent relationship exists between periodontal disease and ischemic stroke, even after adjustment for traditional cerebrovascular risk factors. It remains unknown if the risk of hemorrhagic stroke is increased in subjects with periodontal disease. Periodontal disease prevention and treatment may decrease the incidence of ischemic cerebrovascular disease.