Authors: H. Essa, I. Welters, I. Yasin, A. E. Henney, G. Hernandez, S. Albadri, S. S. Zhao, G. Y. H. Lip, D. J. Cuthbertson & U. Alam
Journal Reference: Essa, H., Welters, I., Yasin, I., Henney, A.E., Hernandez, G., Sondos Albadri, Zhao, S.S., Gregory, Cuthbertson, D.J. and Alam, U. (2025). Increased cardiovascular risk in people with type 2 diabetes and periodontitis: an analysis from a global real-world federated database. BDJ. [online] doi:https://doi.org/10.1038/s41415-025-8889-7.
Background
Periodontitis, a chronic inflammatory condition characterised by the progressive destruction of tooth-supporting structures, is notably more prevalent among individuals with diabetes mellitus. Type 2 diabetes (T2D), which accounts for approximately 90% of all diabetes cases worldwide, is well-recognised as a major risk factor for cardiovascular disease. In individuals with T2D, periodontitis has been linked to worsening glycaemic control, highlighting its systemic relevance beyond the oral cavity. Moreover, the shared inflammatory mechanisms linking periodontitis, T2D and cardiovascular disease, underline a complex but well-established bidirectional relationship, reinforcing the importance of investigating the potential systemic impacts of periodontitis
Aims
This study aimed to investigate whether individuals with both T2D and periodontitis are at a greater risk of developing cardiovascular-related diseases, including infective endocarditis and myocardial infarction, compared to those with T2D alone.
Methods
Data were obtained from the TriNetX Global Collaborative Network, a large-scale database which contains real-world patient data from healthcare organisations covering 14 countries and 163 million individuals. Predefined inclusion and exclusion criteria based on the relevant ICD-10 codes were used; all participants were adults with a confirmed diagnosis of T2D who had begun treatment with insulin therapy. Over 100,000 eligible participants were identified and divided into two cohorts based on the absence or presence of periodontitis. In order to allow robust comparisons to be made, the cohorts were propensity-score matched to balance age, sex and other relevant health factors such as obesity and hypertension. Participants were then followed for three years following the initiation of insulin therapy. The risk of mortality and cardiovascular-related diseases was then assessed in individuals from both cohorts.
Results
Results revealed that participants with periodontitis had a significantly higher risk of stroke, myocardial infarction, atrial fibrillation, atrial flutter, diabetic retinopathy, diabetic nephropathy, infective endocarditis and dementia. Interestingly, no significant difference in the mortality rates between the two cohorts was observed.
Conclusion
The study suggests that periodontitis may act as a potential amplifier of cardiovascular disease risk in individuals with T2D. Thus, incorporating regular periodontal assessment into diabetes care may present a crucial opportunity to mitigate cardiovascular risk.
Research Summary Written By: Arshiya Aryal, University of Manchester – BDS 3