Periodontal Infection and Risk of Myocardial Infarction: A Population-Based Case-control Study
Epidemiological studies have demonstrated a significant association between periodontal disease and increased risk of cardiovascular disease. Periodontal organisms were hypothesized to be the underlying factor for the association. This study investigated the relation of myocardial infarction (MI) with both periodontal health status and presence of periodontal pathogens in subgingival plaque. The study sample included 171 MI cases and 574 controls who had at least 6 teeth and were residents of Erie and Niagara counties of New York. Periodontal assessments included pocket depth and attachment loss. Subgingival plaque was sampled and tested using immunofluorescence microscopic technique for the presence of Bacteriodes forsythus (BF), Porphyromouas gingivilis (PG), Prevotella intermedia (PI), and Campyglobacter recta (CR). Results: Mean (SD) pocket depth (mm) was 2.2 (0.7) for MI cases and 2.0 (0.5) for controls (p<0.01). Mean (SD) attachment loss (mm) was 2.6 (1.2) and 2.2 (0.7) for cases and controls (p<0.01), respectively. Presence of periodontal pathogens was significantly more frequent among MI cases than controls. For the four bacteria (BF, PG, PI, and CR), the prevalence (%) of subgingival bacterum presence was 45.0, 14.6, 39.8, and 12.3 among MI cases, and 26.8, 8.2, 31.2, and 5.1 among controls. After adjustment for sex, age, education, smoking status, alcohol use, body mass index, diabetes status, and dental plaque index using logistic regression, the odds ratios (95% confidence intervals) of MI were 1.62 (1.17-2.25) for pocket depth (per 1 mm change), 1.36 (1.10-1.69) for attachment loss (per 1 mm change), 1.93 (1.30-2.88) for BF, 1.41 (0.81-2.48) for PG, 1.18 (0.80-1.73) for PI, and 1.83 (0.96-3.52) for CR presence in subgingival plaque. In conclusion, this case-control study demonstrated that poorer periodontal status and presence of specific bacteria such as BF in subgingival plaque were associated with an increased risk of MI.