Periodontal disease and acute myocardial infarction: a 24-year prospective study

Objective: To investigate in a longitudinal study the association between periodontal disease and acute myocardial infarction (AMI). The hypothesis was that periodontal disease may accelerate the onset of AMI. Methods: From a cohort of 105798 inhabitants from Stockholm, Sweden, 1676 subjects were included in 1985 for oral examination. The following oral health parameters were recorded: Plaque index (PLI), Calculus index (CI), Gingival index (GI), Pocket depth (PD) and number of missing teeth. 24 years later AMI data (including the date of hospitalization) were collected from the Swedish hospital database using the International Classification of Diseases (WHO ICD-9 ; ICD-10). Pair-wise comparisons and chi-square were the statistical methods used. Results: During the follow-up, out of the 1676 clinically examined subjects 29 had AMI (22 men, 7 women; p<0.01), while 1647 had not. A logistic regression analysis revealed dental plaque as an explanatory variable for AMI (OR=4.5, 95% CI 2.3-8.7; p<0.001). Out of the 29, 6 had periodontal disease while 23 were periodontally healthy. The time from baseline to infarction was 12.7 years in the periodontally diseased vs. 18.4 for the periodontally healthy subjects (p<0.01). No statistical difference was observed in gender, age, socioeconomic status or smoking habits between these groups. Subjects with periodontitis had logically higher gingival index and more periodontal pockets (2.0, 1.3 and 5.3, 0; p<0.001 and p<0.001 respectively). There was no statistical difference seen in PLI, CI or in the number of missing teeth between the groups, however. Conclusion: The 24-year results showed that periodontal disease indeed was linked with the early onset of AMI. Acknowledgement: DFS, Department of Health and Welfare, grant F 84/189 and the Karolinska Institutet, Stockholm Sweden, Philips Oral Healthcare Inc. and The Medical Society of Finland supported this study.