The oral microbiome in the pathophysiology of cardiovascular disease

Despite advances in our understanding of the pathophysiology of many cardiovascular diseases (CVDs) and the expansion of available therapies, the global burden of CVD-associated morbidity and mortality remains unacceptably high. Important gaps remain in our understanding of the mechanisms of CVD and determinants of disease progression. In the past decade, much research has been conducted on the human microbiome and its potential role in modulating CVD. With the advent of high-throughput technologies and multiomics analyses, the complex and dynamic relationship between the microbiota, their ‘theatre of activity’, and the host is gradually being elucidated. The relationship between the gut microbiome and CVD is well established. Much less is known about the role of disruption (dysbiosis) of the oral microbiome; however, interest in the field is growing, as is the body of literature from basic science and animal and human investigations. In this Review, we examine the link between the oral microbiome and CVD, specifically coronary artery disease, stroke, peripheral artery disease, heart failure, infective endocarditis, and rheumatic heart disease. We discuss the various mechanisms by which oral dysbiosis contributes to CVD pathogenesis and potential strategies for prevention and treatment.

Key points
 

• The incidence and prevalence of cardiovascular diseases (CVDs) are increasing despite advances in our understanding of their pathophysiology and an expanded arsenal of treatment options.
• An association between the oral microbiome (or oralome) and cardiovascular inflammation and CVD is supported by a growing body of epidemiological studies, systematic reviews, and basic science investigations.
• Validated links exist between oral dysbiosis and CVDs, including atherosclerotic diseases, heart failure, infective endocarditis, and rheumatic heart disease.
• The mechanisms by which oral dysbiosis contributes to CVD include immunomodulation; endothelial dysfunction; molecular mimicry and antibody cross-reactivity; protein citrullination; platelet activation, aggregation, and thrombogenesis; arterial invasion; and systemic inflammation.
• Targeting oral dysbiosis in a clinical setting could be an important component of CVD management.
   

Reference

Tonelli A, Lumngwena EN, Ntusi NAB. The oral microbiome in the pathophysiology of cardiovascular disease. Nat Rev Cardiol. 2023 Jun;20(6):386-403. doi: 10.1038/s41569-022-00825-3. Epub 2023 Jan 9. PMID: 36624275.