Association between cardiovascular diseases and apical periodontitis: An umbrella review with stratification of evidence and sensitivity analysis

IF 4.8 2区医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE

Journal of dentistry Pub Date : 2025-06-28 DOI:10.1016/j.jdent.2025.105943

Adinath Walmik Talekar , Dax Abraham , Aakansha Puri , Alpa Gupta , Karina Singal , Neha Neha

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引用次数: 0

Abstract

Objectives

To systematically evaluate epidemiological evidence regarding cardiovascular disease (CVD) and apical periodontitis (AP) associations through umbrella review methodology.

Data

Ten systematic reviews were synthesized, including five meta-analyses encompassing 1108–673,083 participants. Meta-analytical effect sizes demonstrated relative risks ranging from 1.20 to 1.38, odds ratios of 1.53 to 2.94, with substantial between-study heterogeneity (I² = 54 %-100 %). The pooled estimates of RR studies were 1.32[1.0 to 1.62; p = 0.007] and for Odds ratio 1.83[1.33 to 2.53; P < 0.001]. Evidence stratification revealed significant heterogeneity in effect magnitudes, methodological approaches, and study quality assessments.

Sources

Comprehensive searches of PubMed/MEDLINE, Scopus, EBSCO Host, and multiple grey-literature repositories were conducted from database inception to February 2025, using optimized strategies that integrated Medical Subject Headings, Boolean logic, truncation, and proximity operators.

Study selection

Dual independent reviewer screening identified systematic reviews examining CVD-AP associations. Following duplicate removal and consensus resolution, 10 systematic reviews were included from 7472 initially screened articles.

Conclusion

This umbrella review of ten systematic reviews—including five meta-analyses spanning 1108 to 673,083 participants—demonstrates a consistent, moderately elevated cardiovascular risk associated with apical periodontitis. Pooled estimates showed a 32 % increase in relative risk (RR = 1.32, 95 % CI = 1.00–1.62; p = 0.007) and an 83 % higher odds of cardiovascular disease (OR = 1.83, 95 % CI = 1.33–2.53; p < 0.001). However, substantial between-study heterogeneity (I² = 54 – 100 %) and variability in diagnostic criteria temper causal inference.

Clinical Significance

Collectively, the evidence supports AP as an independent, clinically important marker of cardiovascular vulnerability, justifying intensified prevention and management of endodontic infection within cardiometabolic risk reduction strategies. Future large, prospective cohorts employing standardized AP definitions and rigorous confounder control are needed to clarify dose-response patterns and underlying mechanisms.

Abstract Image

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心血管疾病与根尖牙周炎的关系：证据分层和敏感性分析的综述。

目的：系统评价心血管疾病（CVD）与根尖牙周炎（AP）相关性的流行病学证据。数据：综合了10项系统综述，包括5项荟萃分析，涉及1,108-673,083名参与者。meta分析效应大小显示相对风险范围为1.20 - 1.38，优势比为1.53 - 2.94，研究间异质性显著（I² = 54%-100%）。RR研究的汇总估计值为1.32[1.0 ~ 1.62；p=0.007]，比值比为1.83[1.33 ~ 2.53；PSources：综合检索PubMed/MEDLINE、Scopus、EBSCO Host和多个灰色文献存储库，从数据库建立到2025年2月，使用优化的策略集成了医学主题标题、布尔逻辑、截断和邻近运算符。研究选择：双重独立审稿人筛选确定了检查CVD-AP关联的系统评价。在重复删除和共识解决后，从最初筛选的7,472篇文章中纳入了10篇系统评价。结论：本综述对10项系统综述（包括5项荟萃分析，涵盖1108至673,083名参与者）进行了综述，结果表明，根尖牙周炎与心血管风险存在一致的中度升高。合并估计显示相对风险增加32% (RR = 1.32,95% CI = 1.00-1.62；p = 0.007)，心血管疾病的几率增加83% (OR = 1.83,95% CI = 1.33-2.53；P < 0.001)。然而，大量的研究间异质性（I² = 54 - 100%）和诊断标准的可变性影响了因果推断。临床意义：总的来说，这些证据支持AP是一个独立的、临床上重要的心血管易感性标志物，证明在心血管代谢风险降低策略中加强根管感染的预防和管理是合理的。未来需要采用标准化AP定义和严格混杂控制的大型前瞻性队列来阐明剂量-反应模式和潜在机制。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of dentistry 医学-牙科与口腔外科

CiteScore

7.30

自引率

11.40%

发文量

349

审稿时长

35 days

期刊介绍： The Journal of Dentistry has an open access mirror journal The Journal of Dentistry: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The Journal of Dentistry is the leading international dental journal within the field of Restorative Dentistry. Placing an emphasis on publishing novel and high-quality research papers, the Journal aims to influence the practice of dentistry at clinician, research, industry and policy-maker level on an international basis. Topics covered include the management of dental disease, periodontology, endodontology, operative dentistry, fixed and removable prosthodontics, dental biomaterials science, long-term clinical trials including epidemiology and oral health, technology transfer of new scientific instrumentation or procedures, as well as clinically relevant oral biology and translational research. The Journal of Dentistry will publish original scientific research papers including short communications. It is also interested in publishing review articles and leaders in themed areas which will be linked to new scientific research. Conference proceedings are also welcome and expressions of interest should be communicated to the Editor.