Researchers at the University of Pittsburgh’s Schools of Medicine and Dental Medicine are advancing understanding of how oral health and cardiovascular disease are biologically connected, with the long-term goal of improving prevention and prediction of heart disease.
The link between oral and heart health has been recognized for decades. Conditions such as gum disease and tooth decay have been associated with cardiovascular disease, largely due to chronic inflammation and oral bacteria entering the bloodstream. However, Pitt researchers are now probing whether a deeper biological connection exists beyond these established pathways.
A research team led by Mariana Bezamat, assistant professor at Pitt’s School of Dental Medicine, published a series of studies in 2025 examining whether shared biological factors could explain the relationship. Their findings suggest that while a direct genetic link between oral disease and cardiovascular disease remains unclear, a shared biological marker may play a key role.
The studies identified a sphingomyelin metabolite that was associated with healthier gums and lower levels of atherosclerosis, a condition marked by plaque buildup in arteries and a major contributor to heart disease. The discovery points to a metabolic connection that may influence both oral and cardiovascular health.
“Dental health is often overlooked, yet its influence extends far beyond the mouth,” Bezamat said. “While oral diseases and atherosclerosis may have distinct genetic roots, overlapping metabolites reveal a link between oral and cardiovascular health. Understanding this connection could elevate the importance of oral health interventions and potentially transform public health policies and health care costs.”
Bezamat’s work focuses on the relationship between oral health and systemic disease, particularly atherosclerotic cardiovascular disease. The research draws on long-standing collaborations with experts across Pitt’s health sciences, including Mary Marazita, Distinguished Professor of Oral Biology; Steven Reis, vice chancellor for multidisciplinary innovations in the health sciences; and Anum Saeed, assistant professor of medicine in the Division of Cardiology.
Much of the data comes from the Heart SCORE study, a longitudinal research project that has followed approximately 2,000 participants for more than 20 years. The study involves extensive annual testing to identify early risk factors for cardiovascular disease. Marazita leads a related effort, Dental SCORE, which includes detailed oral examinations and blood samples from many Heart SCORE participants.
Using this combined dataset, researchers evaluated dental health indicators such as tooth decay, tooth loss and fillings alongside cardiovascular measures. These included calcium buildup in coronary arteries and the thickness of carotid artery walls, both widely used indicators of early cardiovascular disease.
The findings reinforce a consistent correlation between oral inflammation and subclinical cardiovascular disease. However, researchers caution that correlation alone is not enough.
“Our goal is to find a predictive tool,” Saeed said. “We can say with confidence that patients with significant oral inflammation or gingivitis tend to have a higher risk of subclinical cardiovascular disease. But prospectively, we are still working to identify biomarkers that could help predict risk before disease develops.”
Because a strong genetic link has not been established, the team is shifting attention to modifiable factors. These include behavioral and environmental influences that may affect both oral and cardiovascular health and can be addressed through practical, cost-effective interventions.
Bezamat said this approach could expand the role of oral health professionals, positioning dental care as part of a broader strategy to prevent cardiovascular disease. Improved oral hygiene, early detection of gum inflammation and targeted lifestyle changes may ultimately contribute to better heart health outcomes.
Researchers emphasize that further study is needed before any biomarker can be used clinically. Still, they believe the findings mark an important step toward integrating oral health more fully into cardiovascular risk assessment and prevention strategies.