Oral Microbiome Dysbiosis Mediates the Link between Emotional Disorders and Systemic Inflammation in Heart Failure

Emotional disorders (EDs) are prevalent in heart failure (HF) and predict poor outcomes, yet their interplay with oral health and systemic inflammation remains unclear. This integrated cross-sectional analysis of NHANES data and a prospective oral microbiome cohort revealed that EDs were significantly associated with poorer cardiovascular health (Life’s Essential 8 score), an effect partially mediated by tooth loss and self-rated oral health. Furthermore, HF patients with EDs exhibited distinct oral dysbiosis, marked by depletion of beneficial bacteria (e.g., Cardiobacterium ) and enrichment of pro-inflammatory taxa (e.g., Megasphaera ), which correlated with systemic inflammation. Our findings posit that EDs may impact cardiovascular health by disrupting the oral microbiome and promoting inflammation, highlighting a potential psychoneuroimmunological pathway in HF progression. • Emotional disorders in heart failure are linked to poorer cardiovascular health. • This association is partially mediated by objective and subjective oral health. • Heart failure patients with emotional disorders have a distinct oral microbiome. • Their oral microbiota shows fewer beneficial and more pro-inflammatory organisms. • This oral dysbiosis is correlated with elevated systemic inflammation. • A psychoneuroimmunological pathway connecting mood, oral microbiota, and immunity in HF is proposed.