title: Periodontitis Increases the Risk of a First Myocardial Infarction: A Report From the PAROKRANK Study.
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.
  
  
  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.
authors.affiliation: 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.
authors.forename: Lars
authors.initials: L
authors.lastname: Rydén
authors.affiliation: 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.).
authors.forename: Kåre
authors.initials: K
authors.lastname: Buhlin
authors.affiliation: 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.).
authors.forename: Eva
authors.initials: E
authors.lastname: Ekstrand
authors.affiliation: 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.).
authors.forename: Ulf
authors.initials: U
authors.lastname: de Faire
authors.affiliation: 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.).
authors.forename: Anders
authors.initials: A
authors.lastname: Gustafsson
authors.affiliation: 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.).
authors.forename: Jacob
authors.initials: J
authors.lastname: Holmer
authors.affiliation: 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.).
authors.forename: Barbro
authors.initials: B
authors.lastname: Kjellström
authors.affiliation: 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.).
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
authors.affiliation: 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.).
authors.forename: Anna
authors.initials: A
authors.lastname: Norhammar
authors.affiliation: 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.).
authors.forename: Åke
authors.initials: Å
authors.lastname: Nygren
authors.affiliation: 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.).
authors.forename: Per
authors.initials: P
authors.lastname: Näsman
authors.affiliation: 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.).
authors.forename: Nilminie
authors.initials: N
authors.lastname: Rathnayake
authors.affiliation: 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.).
authors.forename: Elisabet
authors.initials: E
authors.lastname: Svenungsson
authors.affiliation: 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.).
authors.forename: Björn
authors.initials: B
authors.lastname: Klinge
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000196:embryology*; D010518:Periodontitis / Q000175:diagnosis* / Q000453:epidemiology*; D058028:Research Report; D012307:Risk Factors
keywords: case-control study; causality; myocardial infarction; periodontitis; radiography, panoramic; risk factors