Periodontitis As A Risk Factor For Stroke: A Systematic Review And Meta-Analysis

Nathalia Carolina Fernandes Fagundes, Anna Paula Costa Ponte Sousa Carvalho Almeida, Kelly Fernanda Barbosa Vilhena, Marcela Baraúna Magno, Lucianne Cople Maia, Rafael Rodrigues Lima, Nathalia Carolina Fernandes Fagundes, Anna Paula Costa Ponte Sousa Carvalho Almeida, Kelly Fernanda Barbosa Vilhena, Marcela Baraúna Magno, Lucianne Cople Maia, Rafael Rodrigues Lima

Abstract

This systematic review and meta-analysis investigate the association between periodontitis and stroke. This review followed the methods established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searches were conducted in five databases and two sources of grey literature. After the selection of the articles, a risk of bias evaluation was performed. Three meta-analyzes were performed: Assessing the overall association between stroke and periodontitis in case-control studies; Ischemic stroke and periodontitis in case-control studies; The association between stroke and periodontitis in cohort studies. Heterogeneity was assessed using the I2 index and the odds ratio was also calculated (p < 0.05). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate the level of evidence. 2193 potentially relevant studies were identified, with 10 studies included in qualitative and quantitative analysis. All the articles were considered with low risk of bias and a low level of certainty. The results demonstrated a positive association between both disorders and increased risk for stroke among cohort studies (RR 1.88 [1.55, 2.29], p<0.00001, I2=0%) and for ischemic stroke events in case-control studies (RR 2.72 [2.00, 3.71], p<0.00001, I2= 4%). Periodontitis may represent a risk factor for stroke, especially in ischemic events. However, new studies with a robust design are necessary for a reliable conclusion.

Keywords: central nervous system; cerebrovascular disorders; periodontal attachment loss; periodontitis; stroke.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2019 Fagundes et al.

Figures

Figure 1
Figure 1
Flow diagram of literature searches and selection, according to the PRISMA statement.
Figure 2
Figure 2
Forest plot to CVA in case–control studies.
Figure 3
Figure 3
Forest plot to Ischemic stroke in case–control studies.
Figure 4
Figure 4
Forest plot to CVA in cohort studies.

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