Int J Stomatol

Int J Stomatol ›› 2021, Vol. 48 ›› Issue (2): 165-172.doi: 10.7518/gjkq.2021040

• Original Articles • Previous Articles     Next Articles

Association between periodontal disease and myocardial infarction: a Meta-analysis of cohort studies

Qin Xiaoru(),Liu Mengyuan   

  1. Dept. of Clinical Medicine, Fenyang College, Shanxi Medical University, Fenyang 032200, China
  • Received:2020-09-26 Revised:2020-11-20 Online:2021-03-01 Published:2021-03-17
  • Contact: Xiaoru Qin E-mail:a13546432963@126.com;a13546432963@126.com
  • Supported by:
    Innovation and Entrepreneurship Training Projects for College Students of Shanxi Province Education Department(2019825)

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Abstract:

Objective This meta-analysis aimed to systematically assess the association between periodontal disease (PD) and myocardial infarction (MI) in cohort studies. Methods We searched the PubMed, Embase, Cochrane library, CNKI, WanFang Data, VIP database, and China Biology Medicine disc database from inception to August 31, 2020 for eligible cohort studies on the association between PD and MI. Two independent reviewers performed the data extraction and assessed the study quality by using the Newcastle-Ottawa scale. A Meta-analysis was performed to pool the risk ratios (RRs) and 95% confidence intervals (CIs) by using the Review Manager 5.3 software. Then, the source of heterogeneity was determined through the subgroup and the sensitivity analyses. Results Eight cohort studies involving 207 922 participants met the inclusion criteria. This Meta-analysis showed that the pooled RR for the association between PD and MI was 1.21 (95% CI: 1.05-1.40, P=0.008). The sensitivity analysis indicated that the results were robust. The subgroup analyses revealed that gender (female: RR=1.39, 95% CI: 1.17-1.65, P=0.000 2; male: RR=1.05, 95% CI: 0.89-1.24, P=0.580), measurement index, effect value, and quality of literature affected the results. Conclusion Given the high-quality evidence from the included cohort studies, results support the presence of a considerable association between PD and MI especially in women.

Key words: periodontal disease, myocardial infarction, cohort studies, Meta-analysis

CLC Number: 

  • R781.4

TrendMD: 

Fig 1

Search strategy and results"

Tab 1

Characteristics of included studies"

纳入研究 国家 研究设计 样本量
（男/女）		 病例数 研究
时间/年		 年龄/岁
（病例/对照）		 测量指标 效应量
（95% CI）		 校正因素
Joshipura
1996[4]		 美国 回顾性队列
研究		 44 119
(男)		 757 6 40~75 未报告 RR=1.04
（0.86~1.25）		 年龄、体质量指数、运动、吸烟饮酒、MI家族史、维生素E
Howell
2001[5]		 美国 回顾性队列
研究		 2 653
(男)		 797 13 40~84 未报告 RR=1.01
（0.82~1.24）		 年龄、阿司匹林、β-胡萝卜素治疗、吸烟、饮酒、高血压、体质量指数、糖尿病、体育活动、MI家族病史
Dorn
2010[6]		 美国 前瞻性队列
研究		 884
（668/216）		 154 8 54.5±8.4 CAL HR=1.48
（0.95~2.31）		 年龄、性别、教育程度、糖尿病、射血分数、高血压、体育活动、胆固醇、降脂药物、体质量指数、水果/蔬菜摄入量、磷酸肌酸酶
Noguchi
2014[7]		 日本 回顾性队列
研究		 3 081
(男)		 17 5 36~59 未报告 OR=2.26
（0.84~6.02）		 年龄、体质量指数、吸烟史、高血压、糖尿病、血脂异常及家族心脏病史
Yu
2015[8]		 美国 回顾性队列
研究		 39 863
(女)		 642 3 48.7~60.3 未报告 HR=1.39
（1.17~1.64）		 年龄
Liljestrand
2015[9]		 芬兰 回顾性队列
研究		 7 629
（3 754/3 875）		 253 13 25~74 缺牙数 HR=1.92
（1.42~2.59）		 收缩压、血压治疗(0~7 d内用药,有或无)、TC、HDL-C、教育程度（3类）、现患有糖尿病
Hansen
2016[10]		 丹麦 回顾性队列
研究		 100 694
（57 421/43 273）		 未报告 14 57.3±15.1/56.6±15.0 未报告 RR=1.16
（1.04~1.30）		 年龄、性别、吸烟、并发症、药物和社会经济地位
Holmlund
2017[11]		 瑞士 前瞻性队列
研究		 8 999
（3 870/5 129）		 672 33 50±13 牙齿数,深牙周袋数*,探诊出血 RR=0.99
（0.92~1.06）		 年龄、性别、教育程度和吸烟

Tab 2

Results of NOS of included studies"

纳入研究 暴露队列的代表性 非暴露队列的选择 暴露的确定 研究开始时未
出现结局事件		 基于设计或分析所得的队列可比性 结局事件
评估		 随访时间
是否充足		 随访队列
是否充足		 总分
Joshipura 1996[4] 1 1 0 1 0 1 1 1 6
Howell 2001[5] 1 1 0 1 0 1 1 0 5
Dorn 2010[6] 1 1 1 1 2 0 1 1 8
Noguchi 2014[7] 1 1 1 1 0 0 0 0 4
Yu 2015[8] 0 1 0 1 0 1 1 1 5
Liljestrand 2015[9] 1 1 1 1 0 1 1 1 7
Hansen 2016[10] 1 1 1 1 2 1 1 1 9
Holmlund 2017[11] 1 0 1 1 0 1 1 0 5

Fig 2

Forest plot of the overall analysis of the association between periodontal disease and MI"

Tab 3

Subgroup analysis of the relationship between periodontal disease and the risk of MI"

亚组 指标 纳入研究数 效应模型 异质性检验 Meta 分析结果
I2/% P值 RR（95%CI） P值
性别 男 3[4-5,7] 随机 18 0.3 1.05（0.89~1.24） 0.580
女 1[8] 随机 - - 1.39（1.17~1.65） 0.000 2
测量指标 CAL 1[6] 随机 - - 1.48（0.95~2.31） 0.08
其他 2[9,11] 随机 94 <0.000 1 1.36（0.71~2.59） 0.36
未报告 5[4-5,7-8,10] 随机 55 0.06 1.16（1.02~1.33） 0.03
效应值 RR 4[4-5,10-11] 随机 47 0.13 1.05（0.96~1.15） 0.29
OR 1[7] 随机 - - 2.26（0.84~6.08） 0.11
HR 3[6,8-9] 随机 40 0.19 1.55（1.26~1.91） <0.000 1
研究质量 中等 5[4-5,7-8,11] 随机 73 0.005 1.11（0.95~1.31） 0.20
高 3[6,9-10] 随机 80 0.006 1.46（1.02~2.07） 0.04

Tab 4

Sensitivity analysis of the overall analysis of the association between PD and MI (one by one exclusion study)"

排除研究 效应模型 异质性检验 Meta 分析结果
I2/% P值 RR（95%CI） P值
Joshipura 1996[4] 随机 82 <0.000 01 1.26（1.06~1.48） 0.008
Howell 2001[5] 随机 82 <0.000 01 1.26（1.07~1.48） 0.006
Dorn 2010[6] 随机 81 <0.000 01 1.20（1.03~1.39） 0.02
Noguchi 2014[7] 随机 81 <0.000 01 1.20（1.04~1.38） 0.01
Yu 2015[8] 随机 70 0.003 1.14（1.01~1.28） 0.04
Liljestrand 2015[9] 随机 76 0.000 3 1.18（1.02~1.37） 0.03
Hansen 2016[10] 随机 81 <0.000 1 1.25（1.03~1.50） 0.02
Holmlund 2017[11] 随机 70 0.003 1.27（1.09~1.49） 0.003
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