Is periodontitis a risk factor for ischemic stroke?: Systematic review and meta-analysis.

Background: Evidence suggests an association between periodontitis and ischemic stroke due to the elevated production of inflammatory markers and damage by infectious agents, which would promote a recurrent prothrombotic state. Therefore, the present systematic review and meta-analysis were carried out to determine whether periodontitis is a risk factor for ischemic stroke.

Material and methods: A systematic search was conducted in five databases, including cohort and case-control studies published up to April 2024, in which periodontitis was evaluated as a risk factor for ischemic stroke through relative risk (RR), hazard ratio (HR) and odds ratio (OR). The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias, and the GRADE system was used to determine the certainty of the evidence.

Results: Of the 1121 studies found, 16 were included in the qualitative analysis, and 10 were meta-analyzed. The global synthesis showed that periodontitis was a risk factor for ischemic stroke (OR=2.59, I2=96%), with the same result being found for the case-control subgroup (OR=3.44, I²=73%) and the cohort subgroup (OR=2.05, I²=99%). Individuals with periodontitis were also found to be more likely to develop lacunar infarcts (OR=5.00, I2=0%).

Conclusions: Periodontitis is a risk factor for ischemic stroke with very low certainty of evidence and high heterogeneity. Furthermore, individuals with periodontitis were more likely to develop lacunar infarcts, with moderate certainty of evidence and null heterogeneity. Key words:Periodontitis, periodontal diseases, ischemic stroke, lacunar infarction, embolic stroke, thrombotic stroke.