C ardiovascular disease is a leading mortality cause, which, despite a recent decline, still contributes to 4 million deaths per year, that is, almost half of all deaths in Europe, whereof ≈30% occurred at <65 years of age. 1It contributes to 22% of all disability-adjusted life-years lost in the European Union and a hospital discharge rate of 2400/100 000 inhabitants.2 Although traditional risk factors are behind a substantial proportion of cardiovascular disease, other factors are important.3 Chronic inflammation accelerates the progress of atherosclerosis, and inflammatory activation increases the risk for plaque rupture leading to acute coronary syndromes. 4,5 Editorial see p 549 Clinical Perspective on p 583Periodontal diseases are inflammatory conditions ranging from gingivitis to severe periodontitis, the latter with a prevalence of 9% in the western European population. 6 The prevalence is age dependent as exemplified by a survey from the United States where it increased from 11% in the age group 50 to 65 years to 20% among those >75 years. 7 The disease, which is diagnosed by clinical and radiographic examination, 8 is a chronic tissuedestructive inflammatory state, predominantly induced by Gramnegative bacteria colonizing the gingival crevice. Background-The relationship between periodontitis (PD) and cardiovascular disease is debated. PD is common in patients with cardiovascular disease. It has been postulated that PD could be causally related to the risk for cardiovascular disease, a hypothesis tested in the Periodontitis and Its Relation to Coronary Artery Disease (PAROKRANK) study. Methods and Results-Eight hundred five patients (<75 years of age) with a first myocardial infarction (MI) and 805 age-(mean 62±8), sex-(male 81%), and area-matched controls without MI underwent standardized dental examination including panoramic x-ray. The periodontal status was defined as healthy (≥80% remaining bone) or as mild-moderate (from 79% to 66%) or severe PD (<66%). Great efforts were made to collect information on possibly related confounders (≈100 variables). Statistical comparisons included the Student pairwise t test and the McNemar test in 2×2 contingency tables. Contingency tables exceeding 2×2 with ranked alternatives were tested by Wilcoxon signed rank test. Odds ratios (95% confidence intervals) were calculated by conditional logistic regression. PD was more common (43%) in patients than in controls (33%; P<0.001). There was an increased risk for MI among those with PD (odds ratio, 1.49; 95% confidence interval, 1.21-1.83), which remained significant (odds ratio, 1.28; 95% confidence interval, 1.03-1.60) after adjusting for variables that differed between patients and controls (smoking habits, diabetes mellitus, years of education, and marital status). Conclusions-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 confoundin...

Hackam DG. Stroke 2016;47:1253-7. Conclusion: Subsequent stroke in association with asymptomatic carotid artery occlusion is relatively infrequent.Summary: Carotid artery occlusion accounts for 10% to 15% of all strokes and transient ischemic attacks (Powers WJ, Curr Treat Options Neurol 2011;13:608-15). The most common pattern of occlusion begins at the origin of the internal carotid artery at the common carotid bifurcation. Wide-scale use of cervical carotid ultrasound has led to large number of patients diagnosed with asymptomatic carotid artery occlusion (ACAO). Some studies of long-term prognosis of ACAO suggest high rates of late neurologic events and other studies have found low rates. This disparity of individual studies led to the authors' decision to perform a systematic review on ACAO with a particular focus on the risk of ipsilateral ischemic stroke. Studies of ipsilateral stroke risk in ACAO were identified by a search of MEDLINE, EMBASE, and study bibliographies. Study estimates were pooled using a random effects model, and heterogeneity was quantified using the I 2 statistics. Primary outcome was the annual rate of ipsilateral stroke. Thirteen studies were identified encompassing 718 patients with ACAO who were followed for a median of 2.8 years. Annual rate of ipsilateral stroke was 1.3% (95% confidence interval [CI], 0.4-2.1; I 2 ¼ 53%). Annual rate of ipsilateral transient ischemic attack was 1.0% (95% CI, 0.3-1.8; I 2 ¼ 40%). Annual rate of death was substantially higher at 7.7% (95% CI, 4.3-11.2; I 2 ¼ 83%). Correction for possible publication bias for the primary outcome suggested a lower risk of ipsilateral stroke (0.3% per year; 95% CI, À0.4 to 1.1).Comment: Subsequent stroke in association with ACAO is infrequent. Such patients, however, have high mortality rates indicating the need for intensified medical therapy of atherosclerotic risk factors in patients with ACAO. This is also possibly indicated by the fact that older studies in this series had higher rates of ipsilateral stroke than more recent studies; perhaps reflecting the greater use of statins, anti-platelet agents, and better blood pressure control in more modern series.