LETTER TO THE EDITOR
Periodontal disease and risk of myocardial infarction
William H. Wehrmacher, MD, FACP, FACCa
a Loyola University Medical Center, 2160 South First Avenue, Office 4644, Maywood, Illinois 60153, USA
As interesting and impressive as "Periodontal Disease and Risk of Subsequent Cardiovascular Disease in U.S. Male Physicians" (1) may be with its study of 22,037 participants, its conclusions are likely to mislead readers and block further essential research on that relationship. The conclusion, excluding a relationship, is in direct conflict with the report of Deliargyris et al. (2) presented at the annual meeting of the American Heart Association last November as well as with my own report in Dentistry Today (3). These latter two reports, contrariwise, "indicate that acute myocardial infarction (AMI) patients are more likely to have periodontal disease than a comparable control population without coronary artery disease."
Hardly recognized by the patient but easily identified by the periodontist, gingivitis with >4-mm pockets (the criteria of Deliargyris et al. (2) for periodontal disease predictive of acute myocardial infarction) would have been largely overlooked by the Howell et al. group (1). It seems almost certain, therefore, that the Howell et al. (1) group of self-reported periodontal disease fails to include many, if not most, cases with gingivitis with >4-mm pockets, which the Deliargyris et al. (2) group found to be predictive of AMI. This makes the sample unreliable for statistical decision making; but even excluding this error, the Howell et al. (1) group reported a "small (10% to 20%), and statistically nonsignificant increased risk for nonfatal myocardial infarction, nonfatal stroke and cardiovascular death" among the group that self-reported periodontal disease.
Although controversy on this matter continues, further investigation remains appropriate. During this time, the patient’s health is likely to benefit; and both physicians and dentists are likely to benefit, professionally, with continued cooperation in further studies.
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References
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1. Howell TH, Ridker PM, Ajani UA, Hennekens CH, Christen WG. Periodontal disease and risk of subsequent cardiovascular disease in U.S. male physicians. J Am Coll Cardiol. 2001;37:445–450[Abstract/Free Full Text]
2. Deliargyris EN, Marron I, Smith SC, Madianos P, Beck JD, Offenbacher S. Periodontal disease and acute myocardial infarction (abstr). Circulation 2000;102 Suppl II:II710.
3. Wehrmacher WH. Periodontal disease predictive and possibly contributive to acute myocardial infarction. Dentistry Today. 2001;20:80–81[Medline]
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