The association between periodontitis and atherosclerotic cardiovascular disease (ASCVD) is stronger than previously recognized, a new scientific statement from the American Heart Association (AHA) suggests.

Evidence also shows that treatment of periodontal disease can reduce inflammatory factors and improve certain intermediate risk markers associated with ASCVD.

However, there is still insufficient evidence to establish a causal relationship, the statement authors said.

“There has been increasing research showing an association between periodontal disease and heart disease; however, additional studies are needed to further clarify mechanisms and long-term effects from childhood into adulthood,” said lead author of the statement, Andrew H. Tran, MD, MPH, assistant professor of pediatric cardiology and director of preventive cardiology at The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio.

“We hope that this scientific statement brings attention to a modifiable risk factor that could decrease the risk of heart disease if addressed and spur additional research in this area,” he said.

Previous research indicates periodontal treatment improves inflammation-related blood markers and some intermediate cardiovascular (CV) risk factors, such as blood pressure and high-density lipoprotein cholesterol.

Who’s Most Affected?

In the US, 42% of adults aged 30 years or older have periodontitis, with 7.8% experiencing severe disease. Severe periodontitis is more common among older adults, smokers, non-Hispanic Black people, and Mexican Americans.

Prevalence also rises with poverty: About 60% of people living below the federal poverty level have periodontitis.

These populations also carry a disproportionately high burden of ASCVD risk.

How the Diseases Are Linked

Studies have identified several plausible biological pathways linking periodontal disease and CV disease. Those studies include a 2024 umbrella review of periodontal disease and CV risk published in BMC Oral Health and a look at the association between these two diseases in a 2025 study published in The International Journal of MolecularSciences.

Direct mechanisms include bacteria entering the bloodstream through bleeding periodontal pockets, leading to systemic inflammation and endothelial dysfunction and potentially contributing to atherosclerotic plaque development or instability, according to the scientific statement. Studies, including a 2025 review in Frontiers in Cellular and Infection Microbiology, also confirm these relationships.

Indirect mechanisms include chronic periodontal inflammation raising circulating CV risk markers, such as C-reactive protein (CRP) and inflammatory cytokines, including interleukin-6 and TNF.

The statement authors also cited additional proposed pathways, including immune cross-reactivity, prothrombotic effects through increased platelet activation, and oral microbiome dysbiosis, all of which may contribute to vascular disease.

Preventive Measures

Oral hygiene measures, scaling and root planing, and, when appropriate, antibiotics have been shown to reduce inflammatory markers such as white blood cell count, fibrinogen, and CRP.

In addition, a meta-analysis reviewed in the AHA statement indicates that periodontal treatment can improve ASCVD-related biomarkers and endothelial function, with the strongest effects observed in individuals with established ASCVD and diabetes.

No Clear Causality

Reviews of multiple Cochrane systematic analyses and key clinical trials indicate that evidence remains insufficient to conclude that periodontal treatment prevents adverse CV events.

Establishing a direct causal link is challenging, largely because both conditions share common risk factors, including smoking, diabetes, hypertension, obesity, and socioeconomic disadvantage.

The authors emphasize the need for further studies examining the long-term impact of periodontal disease and its treatment on CV outcomes.

“This important new American Heart Association scientific statement brings attention to an often-overlooked potential risk factor for heart problems — gum disease,” said Deepak L. Bhatt, MD, MPH, MBA, director of Mount Sinai Fuster Heart Hospital, New York City.

He noted that a prior analysis from the US NHANES registry found a clear relationship between increasing severity of periodontitis and CV risk.

“While a cause-and-effect relationship has not been definitively established, regular brushing, flossing, and dental visits remain sound advice regardless of their direct impact on cardiovascular risk,” said Bhatt, who was not part of the statement writing group.

Bhatt reported having no relevant financial relationships. Tran reported receiving research support in the form of a PEDSnet data analysis voucher and reported having no other relevant financial relationships.

Lois Anzelowitz Levine is a medical writer living in Dallas.