Periodontitis Increases the Risk of a First Myocardial Infarction: A Report From the PAROKRANK Study

Lars Rydén; Kåre Buhlin; Eva Ekstrand; Ulf de Faire; Anders Gustafsson; Jacob Holmer; Barbro Kjellström; Bertil Lindahl; Anna Norhammar; Åke Nygren; Per Näsman; Nilminie Rathnayake; Elisabet Svenungsson; Björn Klinge

doi:10.1161/CIRCULATIONAHA.115.020324

Periodontitis Increases the Risk of a First Myocardial Infarction: A Report From the PAROKRANK Study

Circulation. 2016 Feb 9;133(6):576-83. doi: 10.1161/CIRCULATIONAHA.115.020324. Epub 2016 Jan 13.

Affiliations

¹ From Departments of Medicine K2 (L.R., U.d.F., B.K., A.N., E.S.), Dental Medicine (K.B., E.E., A.G., J.H., N.R., B.K.), and Division of Cardiovascular Epidemiology IMM (U.d.F.), Karolinska Institutet, Stockholm, Sweden; Department Medical Sciences, Uppsala University, Sweden (B.L.); Department of Clinical Sciences Danderyd, Karolinska Institutet, Stockholm, Sweden (Å.N.); Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden (P.N.); and Faculty of Odontology, Department of Periodontology, Malmö University, Sweden (B.K.). lars.ryden@ki.se.
² From Departments of Medicine K2 (L.R., U.d.F., B.K., A.N., E.S.), Dental Medicine (K.B., E.E., A.G., J.H., N.R., B.K.), and Division of Cardiovascular Epidemiology IMM (U.d.F.), Karolinska Institutet, Stockholm, Sweden; Department Medical Sciences, Uppsala University, Sweden (B.L.); Department of Clinical Sciences Danderyd, Karolinska Institutet, Stockholm, Sweden (Å.N.); Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden (P.N.); and Faculty of Odontology, Department of Periodontology, Malmö University, Sweden (B.K.).

PMID: 26762521
DOI: 10.1161/CIRCULATIONAHA.115.020324

Abstract

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 confounding factors. These findings strengthen the possibility of an independent relationship between PD and MI.

Keywords: case-control study; causality; myocardial infarction; periodontitis; radiography, panoramic; risk factors.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Case-Control Studies
Coronary Artery Disease / diagnosis
Coronary Artery Disease / epidemiology
Female
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis*
Myocardial Infarction / embryology*
Periodontitis / diagnosis*
Periodontitis / epidemiology*
Research Report*
Risk Factors