Myocardial infarction, periodontitis and depression

It is known that psychosocial stress and depression are established risk factors for cardiovascular diseases. There is also growing evidence suggesting that periodontitis, an inflammatory disease of the tooth-supporting tissue, is associated with risk of myocardial infarction (MI). Therefore, I read with great interest the research performed by Kjellstrom et al.1 published in this Journal. The authors presented a case control study on 805 patients, <75 years with a first MI and 805 controls without MI. The mean age was 62±8 years and 81% were male. They underwent the standardised MI physical examination and dental panoramic X-ray for grading of periodontal status. The levels of perceived stress at home and work, and symptoms of depression were also assessed.1 The project is impressive in terms of its duration and the number of patients participating. The findings are certainly worth our attention. There is more and more data indicating that periodontitis is associated with increased MI.2,3 Moreover, periodontitis shares some common risk factors with MI, such as diabetes and smoking.4 It has also been indicated that local, systematic inflammation exacerbated by periodontitis might increase the risk of cardiovascular diseases (CVD), including MI events.5