Periodontitis and adverse outcomes in atrial fibrillation: prospective evidence from the UK Biobank

BACKGROUND: Periodontitis (PD), a prevalent chronic inflammatory disease, has been implicated in the pathogenesis of various cardiovascular conditions. Although prior evidence suggests an association between PD and incident atrial fibrillation (AF), its influence on the clinical outcomes in patients with established AF remains poorly understood. OBJECTIVE: This prospective cohort study aimed to explore the associations of PD with all-cause mortality, cardiovascular mortality, incident heart failure (HF) and incident stroke among individuals with AF based on the data from the UK Biobank. METHODS: A total of 3707 AF patients without prior HF or stroke were included. PD was identified by self-reported symptoms of loose teeth or painful gums, an approach validated in prior epidemiological studies. The primary outcome was all-cause mortality; secondary outcomes included cardiovascular mortality, incident HF and incident stroke. Multivariable Cox models were adjusted for demographic factors, lifestyle behaviours and clinical comorbidities. RESULTS: Over a median follow-up of 15.5 years, PD was significantly associated with increased risks of all-cause mortality (adjusted HR: 1.59, 95% CI: 1.26-2.00), cardiovascular mortality (adjusted HR: 1.73, 95% CI: 1.18-2.54) and incident stroke (adjusted HR: 1.60, 95% CI: 1.11-2.30). Although a trend towards higher HF incidence was observed in PD, the association was not statistically significant after full adjustment (adjusted HR: 1.19, 95% CI: 0.92-1.55). CONCLUSION: Among patients with AF, PD is independently associated with higher risks of death and stroke. These results underscore the potential value of integrated periodontal care in the comprehensive management of AF, a hypothesis that merits testing in future randomised controlled trials.