Periodontal disease as a non-traditional risk factor for acute coronary syndrome: a systematic review and meta-analysis.

Q2 Medicine Infezioni in Medicina Pub Date : 2022-01-01 DOI:10.53854/liim-3004-4
Edinson Dante Meregildo-Rodriguez, Luis Gianmarco Robles-Arce, Eleodoro Vladimir Chunga-Chévez, Martha Genara Asmat-Rubio, Petterson Zavaleta-Alaya, Gustavo Adolfo Vásquez-Tirado
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引用次数: 2

Abstract

Objectives: Previous observational studies have suggested an association between periodontal disease (PD) and cardiovascular and cerebrovascular diseases. Nonetheless, evidence linking PD with coronary heart disease (CHD) and acute coronary syndrome (ACS) is still contradictory. We aim to systematically review the role of PD as a risk factor for ACS (myocardial infarction and unstable angina).

Methods: The protocol was registered in PROSPERO (CRD42021286278) and we followed the recommendations of the PRISMA and AMSTAR 2 guidelines. We systematically searched for 7 databases and electronic thesis repositories from inception to February 2022. We included articles without language restriction following the PECO strategy (population: "adult participants"; exposure: "periodontal disease"; comparator: "no periodontal disease"; outcome: "acute coronary syndrome" OR "acute myocardial infarction" OR "unstable angina"). Odds ratios (OR) with 95% confidence intervals (95% CI) were pooled using random effects and heterogeneity was quantified by Cochran's Q and Higgins' I2 statistics. Subgroup analyses were carried out according to the participants' sex, type of diagnosis of PD, type of study, and continent of origin of studies.

Results: We included 46 papers (17 cohort, 25 case-control, and 4 cross-sectional studies) that met the inclusion criteria. This meta-analysis includes a total of 6,806,286 participants and at least 68,932 ACS events, mainly myocardial infarction (MI). In accordance with our results, PD is associated with a higher risk of ACS (OR 1.35; 95% CI 1.25-1.45). However, clinical and methodological heterogeneity was significant (I2=86%, p<0.05). In the sensitivity analysis, the exclusion of some studies with "extreme" results (outliers) did not significantly affect the overall estimate or heterogeneity. In subgroup analysis, we found no statistically significant differences between men and women according to subgroup difference tests (I2=0%, p=0.67). Conversely, there were differences according to the type of diagnosis of PD (clinical or self-reported diagnosis), type of study (cohort, case-control, or cross-sectional study), and the continent of origin (North America, South America, Asia, or Europe) of the studies (I2=79%-96%, p<0.10). Of the 46 studies, only 4 had a high risk of bias. Additionally, the funnel plot suggested publication bias.

Conclusion: PD may be an important non-traditional risk factor for ACS. Although, this meta-analysis brings together more studies, and therefore more evidence, than any other previous similar study, its results should be interpreted with caution due to the great heterogeneity and the potential presence of bias.

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牙周病作为急性冠状动脉综合征的非传统危险因素:一项系统回顾和荟萃分析
目的:先前的观察性研究表明牙周病(PD)与心脑血管疾病之间存在关联。尽管如此,PD与冠心病(CHD)和急性冠脉综合征(ACS)之间的联系仍然存在矛盾。我们的目的是系统地回顾PD作为ACS(心肌梗死和不稳定心绞痛)的危险因素的作用。方法:该方案在PROSPERO注册(CRD42021286278),我们遵循PRISMA和AMSTAR 2指南的建议。从成立到2022年2月,我们系统地检索了7个数据库和电子论文库。我们按照PECO策略纳入了没有语言限制的文章(人群:“成年参与者”;暴露:“牙周病”;比较者:“无牙周病”;结果:“急性冠脉综合征”或“急性心肌梗死”或“不稳定型心绞痛”)。比值比(OR)和95%置信区间(95% CI)采用随机效应合并,异质性采用Cochran’s Q和Higgins’s I2统计量进行量化。根据参与者的性别、PD诊断类型、研究类型和研究起源大陆进行亚组分析。结果:我们纳入了46篇符合纳入标准的论文(17篇队列研究、25篇病例对照研究和4篇横断面研究)。该荟萃分析共包括6,806,286名参与者,至少68,932例ACS事件,主要是心肌梗死(MI)。根据我们的结果,PD与ACS的高风险相关(OR 1.35;95% ci 1.25-1.45)。然而,临床和方法学异质性显著(I2=86%, p2=0%, p=0.67)。相反,根据PD的诊断类型(临床或自我报告诊断)、研究类型(队列、病例对照或横断面研究)和研究的起源大陆(北美、南美、亚洲或欧洲)存在差异(I2=79%-96%)。结论:PD可能是ACS的重要非传统危险因素。虽然,这项荟萃分析汇集了比以往任何类似研究更多的研究,因此也有更多的证据,但由于其巨大的异质性和潜在的偏倚存在,其结果应谨慎解释。
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来源期刊
Infezioni in Medicina
Infezioni in Medicina Medicine-Infectious Diseases
CiteScore
8.40
自引率
0.00%
发文量
62
期刊介绍: The Journal publishes original papers, in Italian or in English, on topics concerning aetiopathogenesis, prevention, epidemiology, diagnosis, clinical features and therapy of infections, whose acceptance is subject to the referee’s assessment. The Journal is of interest not only to infectious disease specialists, microbiologists and pharmacologists, but also to internal medicine specialists, paediatricians, pneumologists, and to surgeons as well. The Editorial Board includes experts in each of the above mentioned fields.
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