Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis

  • Bodanese L
  • Louzeiro G
  • Magnus G
  • et al.
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by the greater number of missing teeth for long exposure to oral diseases. Although there is sufficient evidence to support the relationship between CVD and periodontitis, 9 the association between periodontitis and MI remains unclear in the literature. Most studies have shown the increase of the prevalence of periodontitis in infarcted patients, suggesting a strong association between this condition and the acute ischemic event 10-12. However, few of these studies have addressed periodontitis as a predisposing factor for the development of MI. Thus, the present systematic review aimed to analyze the association between periodontitis and MI. Methods This systematic review and meta-analysis were performed following the PRISMA guidelines, and its protocol was registered in the PROSPERO database (CRD42016052902). Eligibility criteria The inclusion criteria for studies were the following: (i) use of periodontitis as exposure factor and MI as outcome; (ii) observational studies (of all types). There was no language restriction. Case studies, review studies, case series, experimental models, response letters, editorials and duplicated publications were excluded. Duplicate studies were those published by the same study group, with the same inclusion date and population characteristics. In case of duplicate studies, the study with the larger sample size was considered for analysis. The association between exposure and outcome was synthesized from a meta-analysis using estimated risk calculations. Risk of bias was analyzed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. 13 This tool allows the assessment of the risk of bias and the quality of the study, and classified them as "good", "fair" or "bad". "Good" quality was attributed to studies that adopted at least eight of the established criteria. The biases were assessed by two evaluators and, in case of disagreement, a third evaluator was involved. Statistical analysis The association between periodontitis and MI was analyzed using meta-analysis with random-effects models. The heterogeneity among studies was assessed using the Q-Cochran test and I² statistics. We planned to explore heterogeneity using race as a factor, but the studies did not provide sufficient data. For longitudinal and clinical trials that assessed phase angle in more than one moment, the baseline values were considered for analysis. The authors of the present review were aware that some of issues suitable for sensitivity analysis were only identified during the review process, when the characteristics of each study were identified. At this phase of our review, we performed a sensitivity analysis to assess the robustness of our analyses by including only good-quality studies with good quality. The meta-analysis was performed using the Meta R package ( Bodanese et al. Periodontitis and myocardial infarction Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0




Bodanese, L. C., Louzeiro, G. C., Magnus, G. A., Baptista, Â. H., Salum, F. G., & Mattiello, R. (2021). Association between Periodontitis and Myocardial Infarction: Systematic Review and Meta-Analysis. International Journal of Cardiovascular Sciences.

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