Association between periodontitis and acute myocardial infarction: a systematic review and meta-analysis

BACKGROUND: Increasing evidence suggests that periodontitis may elevate the risk of acute myocardial infarction (AMI) through systemic inflammatory pathways. However, the strength and stability of this association remain controversial. OBJECTIVE: The primary objective of this systematic review and meta-analysis was to evaluate whether periodontitis is associated with an increased risk of AMI. The secondary objective was to identify which specific periodontal parameters are most strongly associated with AMI risk. METHODS: Following PRISMA guidelines, PubMed, Embase, Web of Science, and the Cochrane Library were systematically searched from inception to September 25, 2025. Observational studies investigating the association between periodontitis and AMI were included. Two independent reviewers extracted data and assessed study quality using the Newcastle–Ottawa Scale (NOS). Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity, sensitivity, subgroup, and publication bias analyses were also performed. RESULTS: A total of 17 studies comprising 146,001 participants (3,199 AMI cases) were included. Overall results demonstrated a significantly increased AMI risk in individuals with periodontitis (pooled OR = 1.84, 95% CI = 1.51–2.23, I² = 83.3%), and sensitivity analyses confirmed the robustness of the findings. Although publication bias was detected, the trim-and-fill method yielded consistent results (adjusted OR = 1.26, 95% CI = 1.03–1.55). Subgroup analyses revealed that several periodontal parameters were independently associated with AMI, including bleeding on probing (BOP; OR = 2.90), clinical attachment loss (CAL; OR = 1.76), probing depth (PD; OR = 1.15), radiographic bone loss (RBL; OR = 8.85), and remaining bone height (RBH; OR = 1.59). CONCLUSIONS: Periodontitis increases the risk of AMI by approximately 84%, independent of traditional cardiovascular risk factors. The severity of periodontal inflammation and tissue destruction is positively correlated with AMI risk. These findings highlight the importance of integrated prevention strategies for oral and cardiovascular health and the need for prospective clinical trials to confirm causality.