Top Things to Know: Periodontal Disease & Atherosclerotic Cardiovascular Disease
Published: December 16, 2025
Prepared by Barbara Entl, MD, Science and Medicine Advisor, American Heart Association
- Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death globally; in the U.S., it accounts for more deaths annually than cancer and chronic lower respiratory diseases combined.
- A 2012 AHA scientific statement concluded that periodontal disease is associated with ASCVD but called for more robust evidence on clinical outcomes and treatment effects.
- This updated statement builds on prior evidence, highlighting new data supporting an association between periodontal disease and ASCVD while emphasizing potential mechanisms and gaps.
- Periodontal disease is a chronic, multifactorial inflammatory condition affecting over 40% of U.S. adults over 30. It progresses from gingivitis to connective tissue attachment loss and periodontal pocket formation, often followed by destruction of the supporting alveolar bone.
- Shared risk factors (e.g., age, smoking, obesity) contribute to the observed association. However, emerging data suggest biological mechanisms may help explain.
- Direct mechanisms involve bacteremia originating from ulcerated periodontal pockets, with systemic dissemination of oral pathogens—such as Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans—and their virulence factors, including lipopolysaccharides (LPS) and protein-degrading enzymes, which can trigger endothelial dysfunction and vascular inflammation.
- Indirect mechanisms include chronic low-grade systemic inflammation characterized by elevated pro-inflammatory markers (CRP, IL-6, TNF-α) and reduced anti-inflammatory mediators such as adiponectin, a metabolic hormone.
- Additional mechanisms involve molecular mimicry and cross-reactivity, where immune responses to heat shock proteins from periodontal pathogens like P. gingivalis may lead to endothelial injury.
- Epidemiological evidence supports associations between periodontal disease and ASCVD events, including myocardial infarction, stroke, atrial fibrillation, heart failure, and cardiometabolic conditions.
- Despite the growing evidence, causality has not been established. Well-designed longitudinal studies and randomized controlled trials (RCTs) are needed to determine whether periodontal treatment can improve ASCVD outcomes.
Citation
Tran AH, Zaidi AH, Bolger AF, Del Brutto OH, Hegde R, Patton LL, Rausch J, Zachariah JP; on behalf of the American Heart Association Cardiovascular Dis¬ease Prevention Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Clinical Cardiology; Stroke Council; Council on Basic Cardiovascular Sciences; and Council on Cardiovascular and Stroke Nursing. Periodontal disease and atherosclerotic cardiovascular disease: a scientific statement from the American Heart Association. Circulation. Published online December 16, 2025. doi: 10.1161/CIR.0000000000001390