Association Between Periodontitis and Ischemic Heart Disease

ABSTRACT Background Ischemic heart disease (IHD) is a leading cause of global mortality. This study examined the association between periodontitis severity, graded by clinical attachment loss (CAL), and IHD in a representative sample of US adults. Methods We conducted a cross‐sectional analysis of the National Health and Nutrition Examination Survey (NHANES) 2013–2014 cycle, including a full‐mouth periodontal examination, of participants aged ≥30 years with complete periodontal and IHD data ( n = 2807; weighted n ≈ 122,396,066). Periodontal status was classified by maximum interdental CAL, using the severity thresholds of the 2018 classification of periodontal diseases: no‐or‐initial‐attachment loss (CAL ≤2 mm; reference), Stage II periodontitis (CAL 3–4 mm), and Stage III/IV periodontitis (CAL ≥5 mm). IHD was defined as a composite of self‐reported coronary heart disease, angina, or heart attack. Weighted prevalence of IHD was computed for each periodontal group, and survey‐weighted logistic regression estimated odds ratios (ORs) for IHD, adjusting sequentially for demographic characteristics (age, sex, race/ethnicity, and family income), smoking, diabetes, hypertension, and other cardiovascular risk factors. Results The weighted prevalence of IHD was 5.71% overall and increased across periodontal groups: 2.45% (no‐or‐initial‐attachment loss), 4.66% (Stage II), and 8.82% (Stage III/IV) ( p = 0.0004). In unadjusted models, Stage III/IV periodontitis was associated with higher odds of IHD than no‐or‐initial‐attachment‐loss (OR 3.84; 95% confidence interval [CI] 1.33–11.07; p = 0.003). After full adjustment, the association was attenuated, but the point estimate remained elevated (OR 1.47; 95% CI 0.40–5.39; p = 0.05). Older age, current smoking, diabetes, hypertension, and self‐reported bone loss were independent predictors of IHD. Conclusion In this nationally representative study, Stage III/IV periodontitis was associated with a higher prevalence of IHD. Although the association was attenuated after multivariable adjustment, the findings suggest a potential link, possibly mediated by shared risk factors and inflammatory pathways.