title: Symptoms of depression and their relation to myocardial infarction and periodontitis.
abstract: BACKGROUND
  Psychosocial stress and depression are established risk factors for cardiovascular disease and a relationship to periodontitis has been suggested. We studied symptoms of depression and their relation to myocardial infarction and periodontitis.
  
  
  METHODS
  In a Swedish case-control study, 805 patients, <75 years with a first myocardial infarction and 805 controls without myocardial infarction were matched for age, gender and geographic area. Mean age was 62±8 years and 81% were male. Standardised physical examination and dental panoramic X-ray for grading of periodontal status was performed. Medical history including risk factors related to cardiovascular disease and periodontitis was collected as was detailed information on perceived stress at home and work, and symptoms of depression (Montgomery Åsberg Depression Scale). A Montgomery Åsberg Depression Scale score ⩾13 was considered clinically relevant.
  
  
  RESULTS
  A family history of cardiovascular disease, smoking and divorce was more frequent among patients than controls. Patients had more symptoms of depression than controls (14 vs 7%; p<0.001) but received less anti-depressive treatment (16 vs 42%; p<0.001). Symptoms of depression doubled the risk for myocardial infarction (Montgomery Åsberg Depression Scale: odds ratio 2.17 (95% confidence interval 1.41-3.34)). There was no difference in symptoms of depression between study participants with and without periodontitis.
  
  
  CONCLUSIONS
  Patients with a first myocardial infarction were more frequently depressed than matched controls without myocardial infarction, but received less anti-depressive treatment. A relationship between depression and periodontitis could not be confirmed.
authors.affiliation: 1 Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Barbro
authors.initials: B
authors.lastname: Kjellström
authors.affiliation: 2 Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Gustafsson
authors.affiliation: 2 Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Nordendal
authors.affiliation: 1 Department of Medicine, Karolinska Institutet, Stockholm, Sweden.|3 Capio St Görans hospital, Stockholm, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Norhammar
authors.affiliation: 4 Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Åke
authors.initials: Å
authors.lastname: Nygren
authors.affiliation: 5 Center for Safety Research, KTH Royal Institute of Technology, Stockholm, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Näsman
authors.affiliation: 1 Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Rydén
authors.affiliation: 4 Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Åsberg
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology*; D016017:Odds Ratio; D010518:Periodontitis / Q000453:epidemiology / Q000473:pathology* / Q000523:psychology*; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
keywords: Cardiovascular disease; dental health; psychosocial stress; risk factors