Table S3.
General characteristics of the studies included.
| Study, year (Country) | Participants (cases), study design | Sample characteristics | Exposition (PD) | Outcome (ACS) | Adjustment factors | OR /RR /HR (95% IC) |
|---|---|---|---|---|---|---|
| Starkmammart 2008 [16] (Sweden) | 321 (161), CC | Both genders. Age: cases 61.0 ± 8.9 (range 33–76); controls 62.0 ± 8.8 (range 35–78 y). Follow-up 3 y. | Severity grading of PD (Hugoson & Jordan). | Angina (diagnosed as CHD by coronary angiography) | Age, smoking | OR 5.74 (2.07–15.9) for PD and CAD. |
| Andriankaja 2006 [17] (USA) | 1 337 (537), CC | Both genders. Age: cases 54.6 ± 8.5 (range 35–70); controls: 55.0 ± 0.0, (range 36–70 y). Follow-up 4 y. |
CAL, PDe, ACH, NMT | MI | Age, sex, HT, cholesterol, DM and smoking. | OR 2.08 (1.51–2.87) for PD and incidence of non-fatal MI. |
| Andriankaja 2007 [18] (USA) | 1375 (574), CC | Both genders. Age 35–69 y. Follow-up 4 y. |
CAL | Non-fatal MI (WHO criteria). | Age, sex, BMI, physical activity, HT, cholesterol, DM, smoking. | OR 1.34 (1.15–1.57) for men and MI. OR 2.08 (1.47–2.94) for women and MI. OR 1.40 (1.06–1.86) for non-smokers and MI. OR 1.49 (1.26–1.77) for smokers and MI. |
| Rech 2007 [10] (Brazil) | 115 (58/57), CC | Both genders. Age: cases 59.3 y; controls 70 y. Follow-up 1 y. | Gingivitis or Periodontitis. | STEMI and non-STE ACS. | Age, sex, DM, smoking. | OR: 4.5 (1.3–15.6) for PD and MI. OR: 1.8 (0.7–4.7) for PD and ACS. |
| Geerts 2004 [19] (Belgium) | 170 (108), CC | Both genders. Age: cases 59.2 ± 11 y; controls 57.7 ± 9 y. Follow-up 4 y. | PDe, PPBI, PI, FI, TM. | CAD | Age, sex, smoking, alcohol, diet, physical activity, HT, DM, and dyslipidemia. | OR 6.5 (1.8–23) for CAD and PD. |
| Geismar 2006 [46] (Denmark) | 250 (110), CC | Both genders. Age: cases 62.5 ± 11.5 y; controls 62.6 ± 10.5 y. Follow-up 1 y. | PDe, CAL, BOP, ABL on radiographs | CHD | Age, DM, smoking. | OR 6.6 (1.69 –25.6) for individuals <60 years, CHD and mean ABL >4. OR 0.8 (0.26 – 2.69) for individuals ≥60 years, CHD and mean ABL >4. |
| Briggs 2006 [20] (Ireland) | 171 (92). CC | Men >40 y. Age: cases 56.7 y ± 6.3 y; controls 58.2 ± 6.7 y. Follow-up NR. | PI, BOP, PDe. | CHD | Smoking, academic performance, alcohol, unemployment, body weight, exercise, ability to relax daily, hobby, plaque, and CRP. | OR 3.06 (1.02– 9.17) for periodontal status and CHD. |
| Spahr 2006 [21] (Germany) | 789 (263). CC | Both genders. Age: cases and controls: 61 ± 7.1 y. Follow-up 3 y. | CPITN | CHD | Age, sex, BMI, smoking, alcohol, DM, HT, dyslipidemia, education, physical activity, statins use. | OR 1.67 (1.08–2.58) from an increase in mean CPITN score by 1 and CHD |
| Cueto 2005 [22] (Spain) | 149 (72). CC | Both genders. Age: cases 62.5 ± 9.9 y; controls 58.5 ± 10.2 y. Follow-up 2 mo. | Grade of periodontitis: percentage of sites with ICP ≥ 3mm. | MI | Sex, age, smoking, HT, DM, hypercholesterolemia, exercise. | OR 3.31 (1.42 – 7.71) for PD and MI. |
| Anyaipoma 2011 [23] (Peru) | 105(35). CC | Both genders. Subjects >35 y, non-smokers. Follow-up 6 mo. | NT, PDe, adhesion level. | Unstable angina, MI | HBP, DM, hyperlipidemia, obesity | OR 5.899 (1.725 – 20.173) for PD and ACS. |
| Rutger 2003 [24] (Sweden) | 160 (80). CC | Both genders. Age: cases 63.4 ± 8.9 y; controls 61.9 ± 9.1 y. Follow-up NR. | Marginal ABL. | MI | Sex, smoking, socio-economic factors | OR 7.0 (2–24.3) for periodontitis and MI among non-smokers. OR 14.1 (5.8 – 34.4) for PD and MI regardless of smoking status. |
| Nonnemacher 2007 [25] (Germany) | 90 (50). CC | Men. Age: cases 48–80 y, controls 63.6 ±7.3 y. Follow-up 3 y. | PDe, CALe, BOP, TL | CAD (>30% stenosis) | Smoking, BMI. | OR 3.2 (1.2–9.0) for PD and CAD. |
| Buhlin 2005 [26] (Sweden) | 193 (143). CC | Women. Age: cases 65.9 ± 8.6 (range 43–79 y); controls: 64.5 ± 8.3 (range 45–77 y). Follow-up NR. | Remaining teeth, pathological PP (≥ 4 mm). | CHD (treated for MI, PTCA, CABG) | Age, smoking, DM, BMI, education, place of birth. | OR 3.8 (1.68–8.74) for number of PP and CHD |
| Montebugnoli 2004 [40] (Italy) | 113 (63) CC | Men. Age: cases 52.3 ± 4.9 (range 40–65 y); controls: 54.5 ± 6.1 y. Follow-up NR. | TDI, PTS, CPSS, CRSS. | MI <6 months and CHD (≥50% of stenosis) in at least one coronary artery. | Age, smoking, hypertension, DM, education, social class, BMI, total cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, and glucose. | OR 4.61 (1.0–23.20) for CPSS and CHD. |
| Coelho 2005 [41] (Brazil) | 149 (21) CC | Both genders. Age: NR. Follow-up NR. | PDe, CALe | MI and angina | Age, sex, smoking, marital status. | OR 4.03 (0.42– 32.43) for PD and MI/angina. |
| Coelho 2010 [27] (Brazil) | 621 (207). CC | Both genders. Age: 59 (range 40– 81 y). Follow-up 7 mo. | PDe ≥4 mm y PIC ≥ 3mm, y SS |
First MI event | Smoking, education level, occupation, DM, HDL cholesterol. | OR 1.92 (1.13 – 3.23) for PD and MI. |
| Górski 2016 [28] (Poland) | 289 (134) CC | Both genders. Age <70 y. Mean age: cases 54.3 ± 8.1 y; controls 54.9 ± 10.0 y. Follow-up 2 y. | Severity (Page & Eke), extent of periodontitis (Arbes Index), TL >10. | STEMI and STNEMI (ESC). | *Age, sex, smoking, HT, DM, BMI, education, and income. **Age, gender. ***Age, sex, smoking, HT, DM. | OR* 2.4 (1.1 –5.2) for extension de PD and MI. OR** 2.0 (1.2–3.5) for severity of PD and MI. OR*** OR 2.1 (1.2–5.9) for TL and MI. |
| Wojtkowska, 2021 [47] (Poland) | 111 (71) CC | Both genders. Age: cases 54.22 ± 7.05 y; controls 52 ± 8.43 y. Follow-up 10 mo. | Teeth preserved, approximal PI, BOP, PDe, NoPD ≥ 4 mm, %PD ≥ 4 mm, CAL. | MI (4th universal definition). | Age, sex, medication, smoking, DM, BMI, triglycerides, HDL, HT, FBG | OR 1.07 (1.03–1.11) for approximal PI [%]and MI. OR 0.95 (0.9–1.00) for BOP [%]and MI. |
| Holmlund 2011 [29] (Sweden) | 200 (100). CC. | Both genders. Age: cases 57.1 ± 5.5 y; controls 57.9 ± 5.2 y. Follow-up NR. | PBL, NDP, BOP, NT | MI: ECG + CK and troponin T. | Age, sex, CRP, HBP, smoking, IL- 6, cholesterol, HDL, DM, TG, BMI, education. | OR 4.61 (1.52–13.94) for NDP >4 and MI |
| Willershausen, 2014 [48] (Germany) | 497 (248). CC | Both genders. Age: cases 62.3 ± 10.1 (range 51–83); controls 63.5 ± 10.5 y. Follow-up 4 y. | Caries frequency (DMFT indices), NT, PPD, BOP, CALe, radiographs | Recent MI history, catheterization, reperfusion therapy (PTCA, bypass, or thrombolytics) | Sex, age, smoking. | OR 0.879 (0.527–1.466) for generalized PD and MI. OR 1.210 (1.148–1.276) for missing teeth and MI. OR 1.541 endodontic origin and MI. |
| 306 (204). CC | Both genders. Not DM. Age: cases 64.7 ± 12.9 y; controls 64.2 ± 10.1 y. Follow-up 2 y. | CAL, PDe, NMT. | MI (ESC) | Sex, age, smoking, HT, total cholesterol. | OR 2.17 (1.32–3.73) for PDe and MI. OR 1.78 (1.30–2.54) for CAL and MI. OR 1.08 (1.06–1.13) for NMT and MI. | |
| Rydén 2016 [32] (Sweden) | 1610 (805). CC | Both genders. Age 62.5 ± 8 y. Follow-up 6–10 y. | Healthy (≥80% RB), mild- moderate (79%–66% RB), severe PD (<66% RB). | MI (3rd universal definition) | Smoking, DM, education, marital status. | OR 1.28 (1.03–1.60) for PD and MI. |
| Oe 2009 [31] (Japan) | 174 (99). CC | Both genders. Age 65.5 ± 10.6 y. Follow-up 3 y. | PRS (Renvert et al.). | CAD | Statin therapy, DM or glucose intolerance, PRS, HT, smoking | OR: 2.317 (1.162–4.624) for PRS and CAD. |
| Khosravi 2013 [64] (Iran) | 123 (60). CC. | Both genders. Age: cases 54.97 ± 9.68 y; controls: 55.89 ± 11.9 y. Follow-up NR. | PDI (Ramfjord), NMT | Cardiac enzymes and ECG. | Age, DM. | OR 8.79 (2.36–32.66) for LOA (< or > 3mm) and MI. OR 5.44 (1.65–17.94) for NMT (< o > 10) and MI. OR 2.32 (0.59–8.42) for PDI score (< or > 4) and MI. |
| Li 2013 [65] (China) | 155 (103). CC. | Both genders. Age: cases 68 (range 41–84) y; controls 62 (range 42–78) y. Follow-up: NR. | PI, BI, PDe, AL, NMT | Blood tests, ECG and US. | Sex, age, smoking, BMI, DM, HT, serum lipid. | OR 4.89 (1.26–18.94) for AL≥4.00 mm and MI. |
| Beck 1996 [66] (USA) | 1 147 (207) PC | Men only. Age: 21–80 y. Follow-up 18 y. Follow-up NR. | ABL, worst clinical PDe. | Non-fatal MI, angina pectoris, and CHD deaths. | Age, BMI, SBP, cholesterol, DM. | OR 1.49 (1.04–2.14) for ABL and total CHD |
| Hujoel 2000 [42] (USA) | 8032 (1265). PC | Both genders. Age: 25–74 y. Follow-up 8–10 y. |
Russell PI: periodontitis, gingivitis, and no PD. | First event of death from CHD or hospitalization due to CHD, or revascularization procedures. Death certificates and medical records | Multiple cardiovascular risk factors; demographic, socioeconomic factors, race, poverty rate, education, etc. | HR 1.05 (I0.88–1.26) for gingivitis and CHD. HR 1.14 (0.96–1.36) for periodontitis and CHD. |
| Joshipura 1996 [49] (USA) | 44119 (757). RC | Men. Age 40–75 y. Follow-up 6 y. | Self-reported NT (0, 1–10, 11–16, 17–24, 25+). | Incident cases of CHD, including fatal and non-fatal MI and sudden death. | Age, BMI, exercise smoking, alcohol, family history of MI, vitamin E | RR 1.67 (1.03–2.71) for men with positive PD history, NT ≤ 10 compared with those with NT ≥ 25 and CHD. RR 1.11 (0.74–1.68) for men with negative PD history, NT ≤ 10 compared with those with NT ≥ 25 and CHD. |
| Howell 2001 [43] (USA) | 2653 (797) RC | Men. Age 40–84 y. Follow-up 12.3 y. | Self-reported TL. | Nonfatal MI, nonfatal stroke, CV death, all important CV events (WHO criteria). | Age, treatment (aspirin, β-carotene), smoking, alcoholism, HT, BMI, DM, physical activity, paternal history of MI, and history of angina. | RR 1.01 (0.82–1.24) for PD and nonfatal MI. RR 1.00 (0.79–1.26) for PD and CV death. RR 1.01 (0.88–1.15) for PD and all-important CV events. |
| Wu 1999 [50] (USA) | 9962 (803). PC | Both genders. Age 25–74 y. Follow-up 21 y. | Periodontal status: 1) no PD, 2) gingivitis, 3) periodontitis, 4) edentulousness. | CVD events ascertained by hospital records for non-fatal events and death certificates for fatal events. | Demographic variables and various known CV risk factors. | RR 1.03 (0.87–1.21) for gingivitis and CHD; RR 1.14 (0.98–1.34) for periodontitis and CHD; 1.13 (0.98–1.32) for edentulousness and CHD. |
| Noguchi 2015 [51] (Japan) | 3081 (17). RC | Men 36–59 y. Follow-up 5 y. | Self-administered questionnaire: 1) PS, 2) periodontitis, 3) TL (<5 and ≥5 teeth) |
Participants reports of for MI at annual health examinations | Age, BMI, smoking, HT, DM, dyslipidemia, family history of heart disease. | OR 2.11 (1.29–3.44) PS and MI. OR 2.26 (0.84–6.02) for periodontitis and MI. OR 1.97 (0.71–5.45) for TL and MI. |
| Holmlund 2017 [67] (Sweden) | 8999 (672). PC. | Both sexes. Age 50 ± 13 y. (range 20–85 y. Follow-up 15.8 y. | NDP, NT, BOP | CVD: MI, stroke, and HF. CVD diagnosis from the Swedish cause of death and the hospital registers. | Age, sex, educational level and smoking. | RR 1.13 (0.98–1.30) for NDP >4 mm and MI. |
| Hansen 2016 [68] (Denmark) | 100 694 (NR). RC. | Both sexes. Age ≥18 y. Follow-up 15 y. | Clinical examination and radiographic findings. Periodontitis according to ICD-8 and ICD-10. | ICD-10. | Age, sex, smoking, comorbidities, medication and socioeconomic status. | RR: 1.16 (IC 95% 1.04– 1.30) for periodontitis and MI. |
| Lee 2017 [44] (Korea) | 354850 (8164). PC. | Both genders. Age 40–79 y. Follow-up 12 y. | Oral examinations. Assessments of MT, gingivitis, periodontitis, and the deposition of calculus (CDC/AAP criteria). | Diagnosis was made by physicians during visits using ICD-10 codes. | Sex, age, income, insurance, residence, health status, and smoking. | OR: 0.88 (0.81–0.97) for PD and MI. |
| Yu 2015 [33] (USA) | 39 863 (642). RC. | Women ≥ 45 y. Follow-up 15.7 y. | Self-reported PD. | CV deaths confirmed by family members, postal authorities, autopsy reports, MR and the National Death Index. MI was assessed by physician review of MR and cardiac enzymes or ECGs. | Age, race, BMI, education, smoking, DM, HT, dyslipidemia, family history of MI, physical activity. | HR 1.72 (1.25–2.38) for women with incident PD and MI. HR 1.27 (1.04–1.56) for women with prevalent PD and MI. |
| Dorn 2010 [45] (USA) | 884 (154). RC. | Both genders. Age 54 ± 8.5 y. Follow-up 2.9 y. | Mean CAL. | Recurrent overall CVD events (non-fatal, fatal CVD, or cardiac revascularization) | Age, sex, education, DM, total cholesterol, statins, antihypertensives, BMI, physical activity, intake of fruits and vegetables, CPK-MB, ejection fraction. | HR 1.48 (0.95–2.31) for CAL and overall CVD events among never- smokers. HR 1.00 (0.82–1.23) for CAL and overall CVD events among ever-smokers. |
| Liljestrand 2015 [35] (Finland) | 7629 (253). RC. | Both genders. Follow-up 13 y. | NMT | CHD events: a history of MI, revascularizations, or PTCA. | Age, sex, smoking, geographical variable (east/west). | HR 2.39 (1.32–4.31) for NMT 5–8 and incident MI. HR 2.1 (1.19–3.71) for NMT 9–31 and incident MI. |
| Lee 2019 [34] (Korea) | 4440970 (31868). RC. | Both genders. Mean age 41.5 y. Follow-up 7.59 y. | NMT | De novo occurrence of MI, HF, ischemic stroke, and all-cause death (ICD-10). | Age, sex, BMI, DM, HT, dyslipidemia, COPD, CKD, smoking, alcohol, exercise, income. | HR 1.010 (1.007–1.014) for MT and MI. |
| DeStefano 1993 [69] (USA) | 9760 (NR). PC | Both sexes. Age 25–74 y. Mean follow-up 14 y. | 1) Number of decayed permanent teeth. 2) Periodontal classification: no PD; gingivitis; periodontitis; no teeth. 3) PI. 4) OHI. |
CHD: mortality and hospital admission. | Age, sex, race, education, poverty rate, marital status, SBP, total cholesterol, DM, BMI, physical activity, alcohol consumption, and smoking. | RR 1.72 (1.10–2.68) for periodontitis and death from CHD in men aged 25–49 y. RR 1.25 (1.06–1.48) for periodontitis and death from CHD in men and women aged 25–74 y. |
| Lee 2015a [70] (Korea) | 1025340 (8179). RC. | Both genders. Age: 1–80+ y. Follow-up 12 y. | Diagnosis of periodontitis according to AAP and ICD-10. | Diagnosis made by physician and defined according to the KCD-6. | Sociodemographic variables, comorbidities (cerebral infarction, angina pectoris, MI, HT, DM, rheumatoid arthritis, erectile dysfunction, osteoporosis, obesity. | OR 0.98 (0.86–1.12) for periodontitis and MI. |
| Lee 2015b [71] (China) | 720343. (10046). RC | Both genders. Age 20–65+ y. Follow-up 11 y. |
NR | NR | Age, sex, socioeconomic status, residence, comorbidities | HR 1.23 (1.13–1.35) for PD and MI. |
| Morrison 1999 [72] (Canada) | 9331(416). RC. | Both genders. Age 35–84 y. Follow-up 49 y. | None, mild gingivitis, severe gingivitis, pockets, loose teeth, edentulous. | Fatal CHD. | Age, sex, DM, total cholesterol, smoking, HT, and province. | RR 2.15 (1.25–3.72) for severe gingivitis and fatal CHD. RR 1.90 (1.17–3.10) for edentulous and fatal CHD. |
| Bazile 2002 [73] (EUA) | 80 (30). CS | Both genders. Mean age 54 y. (range 23–83). | PI, GI, BOP, PDe, CAL, NMT | MI, SA, UA | Age, sex. | OR 1.23 (0.29–5.23) for CAL and MI. OR 6.10 (1.14–3.26) for CAL UA. |
| Arbes 1999 [52] (EUA) | 5564 (244). CS. | Both genders. Age ≥40 y. | The percent of periodontal sites per person with CAL ≥ 3 mm. | Self-reported history of heart attack (HA) | Age, sex, race, poverty, smoking, DM, HT, BMI, cholesterol | OR 1.38 (0.75–2.54) for CAL >0–33% and HA. OR 2.28 (1.18–4.39) for CAL >33–67% and HA. OR 3.77 (1.46–9.74) for CAL >67% and HA. |
| Holmlund 2006 [74] (Sweden) | 3352 (NR). CS. | Both genders. Age: 20–70 y. | ABL, X-ray, BOP, involvement of furcations. | Self-reported history of HT and MI. | Age, sex, NT, smoking. | OR 2.69 (1.12–6.46) for PD and MI in subjects aged 40–60 y. |
| Parkar 2013 [53] (India). | 60 (30). CS | Both genders. Age: cases 54.3 ± 11.0 y; controls 53.1 ± 10.5 y. | Simplified OHI, CPI, LOA (WHO). | STEMI and NSTEMI verified by ECG and serum troponin I level. | Age, sex, smoking, alcohol, BMI. | OR 0.224 (0.03–1.68) for CPI and MI. OR 0.127 (0.02–1.06) for OHIS and MI. OR 0.79 (I0.009–0.69) for LOA and MI |
CAL: clinical attachment loss; PDe: probing depth; alveolar crest height (ACH); PPBI: periodontal pocket bleeding index; PI: plaque index; FI: furcation involvements; TM: tooth mobility; BOP: bleeding on probing; ABL: alveolar bone loss; CPITN: Community Periodontal Index of Treatment Needs; TL: tooth loss; PP: periodontal pockets; TDI: total dental index; PTS: panoramic tomography score; CPSS: clinical periodontal sum score; CRSS: clinical and radiographic sum score; NoPD ≥ 4 mm: the number of bleeding periodontal pockets ≥ 4 mm in depth; %PD ≥ 4 mm: the percentage of bleeding periodontal pockets ≥ 4 mm in depth; NT: number of teeth; PBL: periodontal bone loss; NDP: number of deepened pockets; PPD: probing pocket depths; CALe: clinical attachment level; NMT: number of missing teeth; RB: remaining bone; Periodontal diseases index (PDI); BI: bleeding index; AL: attachment level; PI: periodontal index; OHI: oral hygiene index; PS: periodontal score; GI: gingival index; CPI: community periodontal index; LOA: loss of attachment; PRS: Periodontal risk score; CHD: coronary heart disease; CAD: coronary artery disease; STE: ST segment elevation; ACS: acute coronary syndrome; MI: myocardial infarction; STEMI: ST segment elevation MI; NSTEMI: non-ST segment elevation MI; CV: cardiovascular; CVD: cardiovascular disease; HF: heart failure; ECG: electrocardiogram; PTCA: percutaneous transluminal coronary angioplasty; SA: stable angina; UA: unstable angina; CABG: coronary artery bypass grafting; BMI: body mass index; HT: hypertension; DM: diabetes mellitus; FBG: fasting blood glucose; SBP: systolic blood pressure; US: ultrasonography; WHO: World Health Organization; ESC: European Society of Cardiology; CDC: Centers for Disease Control and Prevention; AAP: American Academy of Periodontology; MR: medical records; KCD-6: Korean Classification of Disease 6TH edition; CC: case-control study; PC: prospective cohort study; RC: retrospective cohort study; CS: cross-sectional study; NR: no reported.