More Evidence Links Oral Health and Gut Bacteria to Cardiovascular Disease

There is a direct link between systemic inflammation, coronary artery disease, and an excess of bacteria commonly found in the mouth. That’s the conclusion of a recent cross-sectional study published in the journal Circulation that featured nearly 9,000 participants aged 50 to 65 without overt heart disease. 

The study looked at coronary artery calcium scores and coronary computed tomography angiography, as well as inflammatory markers in saliva. Gut microbiota species were assessed using shotgun metagenomics sequencing of fecal samples. The researchers found that the Streptococci species in saliva correlated with worse dental health, higher C-reactive protein, and increased artery calcium scores independent of cardiovascular risk factors. The strongest associations were with Streptococcus anginosus and Streptococcus oralis.

“This latest study is clearly further confirmation of a crucial but often forgotten area of risk for cardiovascular disease—oral health,” said Daniel Chong, ND, who is a cardiovascular specialist. “Research illustrates that the oral microbiome and the presence of certain bacterial infections in the mouth can have a major impact on the risk of cardiovascular disease.”

Chong, a clinician with BioLounge in Portland, Ore., makes it a habit of asking patients about their dental hygiene and dental health including any history of gum disease or root canals. “If necessary, I readily refer patients to dentists who are well versed in this area and have the capacity to do 3D Cone-Beam Computed Tomography and oral bacteria evaluation to better rule out subtle infections and assess the patient’s overall microbiota picture,” said Chong. 

It is estimated that 45 percent to 50 percent of the world’s population has periodontitis and that there is a significant association between this condition and cardiovascular disease. While this study highlights the dangers of some oral bacteria, research is also showing that gut microbiota can help reduce the risk of cardiovascular disease. 

The Flipside

The inhabitants of the gut have a broad influence on health, including cardiovascular health. This latest study illustrates increased risk, but other research points to reducing risk via specific probiotic strains.

"Certain species of gut microbiota, such as lactobacillus rhamnosus specifically and lactobacilli and bifidobacterium, in general, can help reduce risk,” explained Chong. “There is also a question of the interplay of the gut microbiota, different types of foods, and TMAO.” 

According to a 2022 review published in the International Journal of Molecular Sciences, mounting evidence demonstrates that supplemental probiotics and prebiotics may help treat various metabolic disorders, including cardiovascular disease and its risk factors, such as high cholesterol and hypertension.

In addition, a 2022 randomized double-blind controlled trial in the journal Diabetology & Metabolic Syndrome featuring patients with type 2 diabetes found that probiotic supplementation for six weeks led to a significant improvement in major cardiovascular disease-related parameters. 

Integrative Cardiovascular Care

The growing research in this area helps emphasize the importance of addressing the comorbidity of periodontal disease in clinical practice to help reduce the risk of cardiovascular disease. In addition to oral health, the landscape of the gut microbiome provides clues as to how clinicians can enhance heart health and overall health in general.

“While most integrative practitioners are already appropriately placing heavy emphasis on optimizing gut health and the microbiome, this latest study serves as an added reason to consider the microbiome when trying to reduce the risk of heart disease,” said Chong. In addition, he says “it’s crucial that we talk to our patients about dental health and have a good dentist in the community to refer patients to.”