Periodontal diseases and coronary artery disease: epidemiological links, pathogenic mechanisms and prospects for comorbidity integrated management.

Periodontal disease (PD) and coronary artery disease (CAD) are two highly prevalent chronic systemic disorders with overlapping population risk profiles. Accumulating observational, cellular, and genetic studies have suggested potential positive correlations between PD severity, periodontal pathogen load, and CAD incidence, coronary lesion severity, and major adverse cardiac events, whereas Mendelian randomization analyses may not support a direct causal link between the two illnesses. Several synergistic pathogenic pathways may mediate their association: periodontal pathogens may translocate into peripheral circulation to colonize atherosclerotic plaques and exert potential direct vascular toxicity; sustained systemic low-grade inflammation may disrupt endothelial homeostasis; molecular mimicry may induce cross-autoimmune vascular impairment; shared susceptibility loci and conventional cardiovascular risk factors may jointly amplify vascular damage. Standard non-surgical periodontal therapy may reduce systemic inflammatory burden and improve endothelial function, and clinical and microbial periodontal markers may serve as non-invasive biomarkers for CAD risk stratification. This review synthesizes epidemiological evidence and multilayered pathogenic mechanisms and proposes bidirectional collaborative interventions and multidisciplinary cardiostomatological management frameworks for comorbid patients. Further large-scale randomized controlled trials and multi-ethnic genetic analyses are still required to clarify causal inference and potential long-term cardiovascular benefits of periodontal intervention.