Periodontitis Increases Risk of a First Myocardial Infarction

Study Questions:

Periodontitis (PD) is common in cardiovascular disease (CVD). Is PD causally related to the risk for CVD?


The PAROKRANK study (Periodontitis and its relation to coronary artery disease), a multicenter case-control Swedish study, was conducted in 805 patients (ages <75 years) with a first myocardial infarction (MI) and 805 age (mean 62 ± 8 years), gender (male 81%), and area well matched controls without MI. Each underwent standardized dental examination including panoramic x-ray. The periodontal status was defined as healthy (≥80% remaining bone) or as mild-moderate (79-66%) or severe PD (<66%). Odds ratios (ORs) (95% confidence intervals [CIs]) were calculated by conditional logistic regression.


CV risk factors were similar, except for an increase in family history of CVD, chronic obstructive pulmonary disease, and smoking on admission in patients with an MI. PD was more common (43%) in patients than in controls (33%; p < 0.001). Use of evidence-based treatment for MI was very high in the patients. There was no difference in high-sensitivity C-reactive protein. There was an increased risk for MI among those with PD (OR, 1.49; 95% CI, 1.21-1.83), which remained significant (OR, 1.28; 95% CI, 1.03-1.60) after adjusting for variables that differed between patients and controls (smoking habits, diabetes, years of education, and marital status).


In this large case-control study of PD, verified by radiographic bone loss and with a careful consideration of potential confounders, the risk of a first MI was significantly increased in patients with PD even after adjustment for confounding factors. These findings strengthen the possibility of an independent relationship between PD and MI.


The relationship between PD and CVD including revascularization, MI, stroke, and PVD is inferred, but has not been consistent in epidemiological studies. This study design is unique as is the power, use of patients with a first acute MI and matched controls, and standard definitive radiographic criteria for PD. Among the putative relationships has been the heightened inflammation attributable to periodontal disease as a trigger and the presence of anaerobic bacterial flora found in plaque that predisposes to instability. Whilst the relationship between PD and CVD is not proven, this study adds to the data in support of treating and preventing periodontal disease to enhance overall health, and preventing CVD and coronary risk factors.

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