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Periodontal Status, C-Reactive Protein, NT-proBNP, and Incident Heart Failure: The ARIC Study.

TitlePeriodontal Status, C-Reactive Protein, NT-proBNP, and Incident Heart Failure: The ARIC Study.
Publication TypeJournal Article
Year of Publication2022
AuthorsMolinsky RL, Yuzefpolskaya M, Norby FL, Yu B, Shah AM, Pankow JS, Ndumele CE, Lutsey PL, Papapanou PN, Beck JD, Colombo PC, Demmer RT
JournalJACC Heart Fail
Date Published2022 Oct
KeywordsAged, C-Reactive Protein, Heart Failure, Humans, Middle Aged, Natriuretic Peptide, Brain, Peptide Fragments, Stroke Volume

BACKGROUND: Periodontal disease (PD), resulting from inflammatory host response to dysbiotic subgingival microbiota, has been linked to cardiovascular disease; however, its relationship to heart failure (HF) and its subtypes (heart failure with reduced ejection fraction [HFrEF] and heart failure with preserved ejection fraction [HFpEF]) is unexplored.

OBJECTIVES: The authors hypothesize that the presence of PD is associated with increased risk of incident HF, HFpEF, and HFrEF.

METHODS: A total of 6,707 participants (mean age 63 ± 6 years) of the ARIC (Atherosclerosis Risk In Communities) study with full-mouth periodontal examination at visit 4 (1996-1998) and longitudinal follow-up for any incident HF (visit 4 to 2018), or incident HFpEF and HFrEF (2005-2018) were included. Periodontal status was classified as follows: healthy, PD (as per Periodontal Profile Classification [PPC]), or edentulous. Multivariable-adjusted Cox proportional hazards models were used to calculate HRs and 95% CIs for the association between PPC levels and incident HF, HFpEF, or HFrEF. Additionally, biomarkers of inflammation (C-reactive protein [CRP]) and congestion (N-terminal brain natriuretic peptide [NT-proBNP]) were assessed.

RESULTS: In total, 1,178 incident HF cases occurred (350 HFpEF, 319 HFrEF, and 509 HF of unknown type) over a median of 13 years. Of these cases, 59% had PD, whereas 18% were edentulous. PD was associated with an increased risk for HFpEF (HR: 1.35 [95% CI: 0.98-1.86]) and significantly increased risk for HFrEF (HR: 1.69 [95% CI: 1.18-2.43]), as was edentulism: HFpEF (HR: 2.00 [95% CI: 1.37-2.93]), HFrEF (HR: 2.19 [95% CI: 1.43-3.36]). Edentulism was associated with unfavorable change in CRP and NT-proBNP, whereas PD was associated only with CRP.

CONCLUSIONS: Periodontal status was associated with incident HF, HFpEF, and HFrEF, as well as unfavorable changes in CRP and NT-proBNP.

Alternate JournalJACC Heart Fail
PubMed ID36175058