Abstract Body (Do not enter title and authors here): Background: Heart failure (HF) is impacted by non-traditional factors like emotional disorders(anxiety/depression). Oral health's link to cardiovascular disease is growing, with oral microbiota dysbiosis potentially contributing via inflammation and endothelial dysfunction. Whether emotional disorders indirectly affects HF through oral microecology is unclear, though stress may alter the oral microbiota via saliva, immunity, and hygiene. If so, targeting the oral cavity could offer new HF interventions. This study explores emotional disorders' bridging role between oral health and HF progression.
Research Questions: Does emotional disorders influence oral health indicators and cardiovascular risk? What is the specific impact of emotional state on the oral microbiota of HF patients?
Methods: We used NHANES (2009-2012, n=4823) for associative analysis, examining emotional disorders, oral health (missing teeth, periodontitis, self-rating), and cardiovascular health (LE8). Analyses included weighted logistic regression, stratified analysis, mediation analysis (using the systemic immune-inflammation index), and RCS curves. Omics analysis used 16S rRNA/ITS sequencing to compare oral microbiota of HF patients with vs. without emotional disorders, employing ternary plots, differential analysis, and functional predictions.
Results: Emotional disorders was associated with lower LE8 scores, more missing teeth, and poorer self-rated oral health (p<0.05), but not periodontitis (p=0.53). The systemic immune-inflammation index was not a significant mediator (p=0.78), whereas missing teeth (p=0.02) and self-rated oral health (p<0.0001) were partial mediators of disorders' effect on cardiovascular health. RCS curves showed emotional disorders incidence decreased with higher LE8 scores but increased with more missing teeth. In microbiome analysis, potential beneficial bacteria (Cardiobacterium, Propionivibrio) and harmful bacteria (Megasphaera) were identified, alongside harmful fungi (Malasseziaceae), overlapping with previously reported dysbiotic taxa in HF patients.
Conclusion: Emotional disorders significantly impact cardiovascular health, potentially mediated by both objective and subjective oral health measures. It may disrupt oral microbiota balance. As psychological support is already recognized in HF guidelines, our findings highlight the importance of emotional management. Integrating emotional and oral health strategies into HF care may open new therapeutic avenues.