Periodontitis Increases the Risk of a First Myocardial Infarction

Abstract

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...

Increasing Evidence for an Association Between Periodontitis and Cardiovascular Disease

“…The Periodontal Disease and the Relation to Myocardial Infarction (PAROKRANK) study, 9 published in this issue of Circulation, strengthens the evidence for a link between periodontal disease and first myocardial infarction. This Swedish study compared periodontal disease in 805 patients who had presented with a first myocardial infarction with 805 controls.…”

“…4 This caution remains appropriate. The PAROKRANK study 9 adds to the strong evidence for an association between periodontitis and myocardial infarction, but does not prove causation. However, knowledge that the association is at least partly explained by common risk factors is important, because it provides further evidence that strategies to reduce cardiovascular risk, such as the American Heart Association's Life's Simple 7, are also likely to benefit other determinants of good health.…”

“…Smoking, diabetes mellitus, increasing age, and poor socioeconomic conditions are risk factors for periodontitis, and for cardiovascular disease, as well. 1 In the PAROKRANK study 9 controls were matched to cases for age, sex, and area of residence, a surrogate indicator of socioeconomic status. However, there were modest differences in smoking, diabetes mellitus, hemoglobin A1c, and divorce or living alone between cases and controls.…”

Immunoglobulin G antibodies againstPorphyromonas gingivalisorAggregatibacter actinomycetemcomitansin cardiovascular disease and periodontitis

“…The disease affects 50% of the adult population [2] and is diagnosed on the basis of clinically evident inflammation, loss of attachment associated with periodontal pocket formation, and alveolar bone loss [3]. In a recent study, the risk of myocardial infarction was significantly increased in patients with periodontitis [4]. Accordingly, recent meta-analyses demonstrated significantly increased risk of developing cardiovascular disease (CVD) in patients with periodontitis [5,6].…”

Associations between tooth loss and prognostic biomarkers and the risk for cardiovascular events in patients with stable coronary heart disease

“…Baseline blood samples were obtained and patients reported their number of teeth according to the following tooth loss levels: "26-32 (All)" [lowest level], [20][21][22][23][24][25][15][16][17][18][19][1][2][3][4][5][6][7][8][9][10][11][12][13][14]and "No Teeth" [highest level]. Linear and Cox regression models assessed associations between tooth loss levels, biomarker levels and the relationship between tooth loss levels and outcomes, respectively.…”