This limitation likely attenuated the associations in groups with fewer missing teeth but does not diminish the relevance of the findings in the > 20 teeth group, which is epidemiologically more representative of severe periodontitis.Fifth, the diagnosis of heart failure was based on echocardiographic criteria and clinical assessment but did not incorporate biomarkers such as NT-proBNP, which might improve diagnostic precision. This evidence concerns the gene NPPB and heart failure.