Want a Low-Cost Way to Prevent Heart Failure? Brush Your Teeth, Study Suggests

As the population ages, rising rates of heart failure (HF) have clinicians and researchers alike looking for ways to prevent this debilitating, costly disease. Alongside known risk factors like hypertension, smoking, and alcohol use, it might be time to add another: failing to brush your teeth.

Researchers from Ewha Womans University in Seoul, South Korea, published findings Sunday in the European Journal of Preventive Cardiology that suggest a link between oral hygiene and reduced risk of HF and possibly atrial fibrillation (AF), based on a study of 161,286 patients registered with the country’s National Health Insurance System.

More studies will be needed to explore the link. The authors say that better oral hygiene “may decrease the risk of AF and HF,” even though they found that the strength of the association declined after controlling for demographic factors, alcohol use, and certain cardiometabolic risk factors.

After a follow-up of 10.5 years, 4911 (3%) of the patients developed AF, while 7971 (4.9%) developed HF. Frequent tooth brushing—at least 3 times a day—was associated with a 10% reduced risk of AF and 12% reduced risk of HF. Having one’s teeth cleaned at the dentist was associated with a slightly lower HF risk, while missing teeth increased the risk by a third (32%). The authors found:

• The hazard ratio (HR) for AF was 0.90 (95% CI, 0.83-0.98).
• The HR for HF was 0.88 (95% CI, 0.82-0.94).

The connection between oral hygiene and HF is not new; a 2017 study in ESC Heart Failure found that patients with HF have more severe periodontal disease, with “increased bone turnover markers” when compared with control patients. Still, that study found that local or system factors could account for the link and more studies were needed.

What’s the connection? The authors write, “Poor oral hygiene can provoke transient bacteremia and systemic inflammation, a mediator of atrial fibrillation and heart failure.”

Although the study did not pinpoint the exact mechanism behind the link, the authors wrote that the presence of plaque below the gumline can allow oral bacteria to reach the circulatory system; of note, Porphyromonas gingivalis can alter gut bacteria and trigger inflammation. Patients with periodontal disease often have elevated levels of biomarkers associated with inflammation, including tumor necrosis factor-α and interleukin-6.

The association between dental care and condition was not precisely the same for AF and HF. Lower risk of AF was linked to the presence of periodontal disease, professional dental cleaning, and a lower number of missing teeth; lower risk of HF was linked to a dental visit for any reason.

Once the researchers adjusted for the demographic confounding factors, however, “These associations became statistically insignificant. This indicates that other factors might be associated with AF and HF rather than poor oral hygiene and/or improving oral hygiene behaviors.”

A recent study from Kaiser Permanente found that deaths from HF are rising in the United States, in part because the population is aging, but also because patients who might not have survived a heart attack decades ago are now living longer, thanks to improvements in care. A new drug class, sodium glucose co-transporter 2 (SGLT2) inhibitors, is being studied for its potential in preventing events related to HF.

Paying for dental care could be challenging for seniors, depending on which coverage option they select in Medicare. Traditional fee-for-service Medicare does not cover dental services, while some Medicare Advantage (Part C) plans include dental.

Reference

Chang Y, Ho GW, Park J, Lee JS, Song TJ. Improved oral hygiene care is associated with decreased risk of occurrence for atrial fibrillation and heart failure: a nationwide population-based cohort study [published online December 1, 2019]. Eur J Preven Cardiol. doi: 10.1177/2047487319886018.