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Setting the record straight

Revised AHA news release seeks end to confusion over relationship between gum disease, heart disease

Nearly a month after issuing a news release that fueled widespread confusion and controversy, the American Heart Association distributed a second release to clarify its views on the relationship between periodontal disease and atherosclerotic vascular disease.

The AHA’s newer release, dated May 15, followed an April 18 statement that appeared to downplay the merits of treating gum disease as one way to combat the threat of heart disease.

The new release, like the older one, notes that periodontal disease and heart disease share common risk factors such as smoking, age and diabetes. But unlike the original release, the newer press statement acknowledges that “studies have found an association between the two diseases that cannot be explained by the common risk factors.”

The newer release goes on to note that more evidence is needed to establish an incontestable causative relationship between periodontal disease and atherosclerotic heart disease.

Both news releases centered on a statement published April 18 in AHA’s journal Circulation. The statement described a review of hundreds of articles from professional journals exploring the relationship between periodontal disease, on the one hand, and heart disease and stroke on the other.

Though a causative relationship was not defined, the statement acknowledged the association between the two diseases—a crucial detail omitted from the original news release.  It was an omission that had sweeping consequences in how the news media, including the ADA News, interpreted and reported the findings.

Headlines that echoed across the country wrongly declared that “gum disease is no risk to your heart” (Newsday, April 19). Others mistakenly reported “No link between gum disease and heart disease” (CBS News, April 19; Philadelphia Inquirer, April 30); “Flossing is good for the gums, but doesn’t help the heart” (National Public Radio, April 19).

“That first press release triggered a lot of controversy,” said Dr. Robert Faiella, ADA president-elect and a periodontist. “We know there are associations between periodontal disease and atherosclerotic vascular disease. We know those associations exist in the absence of confounders. It’s not a coincidence that if you correct for the confounders that are common, you still see an association that is unexplained at this point.”

The controversy over the AHA statement spurred a discussion at the June meeting of the ADA Board of Trustees.

“The Board was pleased to see the restatement of the press release by the AHA,” said Dr. Faiella. “The fact that the American Heart Association took notice and rethought their press release is an acknowledgement of our role as leaders in oral health, working in collaboration with other organizations in health care.”

The ADA, through its Council on Scientific Affairs, had accepted the conclusions in the AHA statement, as did the American Academy of Periodontology. But both organizations strongly objected to AHA’s first press statement.

“It may be overly simplistic to expect a direct causal link” between gum disease and heart disease, said Dr. Pamela McClain, AAP president. “The relationship between the diseases is more likely to be mediated by numerous other factors, mechanisms and circumstances that we have yet to uncover. However, as the AHA statement points out, the association is real and independent of shared risk factors.”

This issue of the ADA News includes a “My View” commentary on the complexity of periodontal disease reprinted from the AHA website. The author is Dr. Lauren L. Patton, professor and chair, Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill.

Also, in the August edition of The Journal of the American Dental Association, two of the authors of the AHA statement on periodontitis and atherosclerotic vascular disease—Dr. Panos Papapanou, a periodontist, and Maurizio Trevisan, M.D., a cardiologist—will present a guest editorial exploring what is known about the association between the two diseases.

In their commentary, they state as a mater of fact that “periodontitis is associated with increased risk for atherosclerosis; the association is independent and cannot be attributed to shared risk factors.”

Dr. Faiella, the ADA president-elect, said the need to set the record straight on this matter harkened to the Association’s role as described in one of its four strategic goals—Goal 2, which calls for the ADA to be the trusted resource for oral health information.

“We have to be sure that the information out there for the public, our members and the profession is accurate,” he said. “The bottom line is that we need to keep doing research to better understand the relationship between these diseases.”