Relationship between Acute Myocardial Infarction and Periodontitis
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Relationship between Acute Myocardial Infarction and Periodontitis: A Case-Control Study of Northern Indian Population

Subject Area: Education / Adult Learning / Biostatistics

Modified: 20th August 2025

This study explores the association between Acute Myocardial Infarction (AMI) and periodontitis among a North Indian population through a case-control design. The statistical analysis used various tests and regression models to examine the relationship between different factors (e.g., smoking, hypertension, diabetes, periodontitis, etc.) and AMI.

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Test for Normality

To test the assumption of normality, the Kolmogorov-Smirnov and Shapiro-Wilks tests were used. The null hypothesis states no significant departure from normality, while the alternative suggests a departure. If p < α (0.001), the null hypothesis is rejected. Table 1 shows that for each level of the independent variable, p < 0.001 and p < 0.05, indicating that the variables are not normally distributed. Hence the assumption of normality had not been met for this sample.

Table Of Content

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S. No

Contents

Page

1

Test for Normality

2

2

Descriptive Statistics

3

3

Mean Ranks differences between cases and controls

6

4

Association between Acute Myocardial Infarction and study variables

7

5

Cox Regression

7

Test for Normality

Case/Control 

Kolmogorov-Smirnov 

Shapiro-Wilk 

Statistic 

df 

Sig. 

Statistic 

df 

Sig. 

DMFT_S 

.170 

40 

.005 

.915 

40 

.005 

 

CPI_S 

.308 

40 

.000 

.734 

40 

.000 

 

LOA_S 

.315 

40 

.000 

.747 

40 

.000 

 

DMFT_S 

.145 

40 

.034 

.936 

40 

.025 

 

CPI_S 

.194 

40 

.001 

.865 

40 

.000 

 

LOA_S 

.254 

40 

.000 

.816 

40 

.000 

 

 

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Descriptive Statistics

 

Mean 

SD 

Minimum 

Maximum 

Indivi_DMFT 

17.28 

11.64 

1.41 

44.41 

Indivi_CPI 

16.85 

8.39 

10.51 

38.49 

Indivi_LOA 

14.33 

13.48 

.64 

41.14 

Case/Control 

0.50 

0.50 

.00 

1.00 

SD- Standard Deviation 

Mean Ranks differences between cases and controls

 

Case/Control 

N 

Mean Rank 

Sum of Ranks 

DMFT Score 

Case 

40 

50.41 

2016.50 

Control 

40 

30.59 

1223.50 

Total 

80 

 

 

CPI Score 

Case 

40 

51.99 

2079.50 

Control 

40 

29.01 

1160.50 

Total 

80 

 

 

LOA Score 

Case 

40 

51.14 

2045.50 

Control 

40 

29.86 

1194.50 

Total 

80 

 

 

 

Association between Acute Myocardial Infarction and study variables

Variables 

Controls (n=40) 

Cases (n=40) 

Odds ratio (95% CI) 

P-value 

Periodontitis status, n (%) 

 

 

 

0.026* 

Absent 

16 (40.0) 

7 (17.5) 

 

 

Present 

24 (60.0) 

33 (82.5) 

0.318 (0.113-0.893) 

 

Smoking habits  

 

 

 

0.031* 

Non-smoker 

11 (27.5) 

11 (27.5) 

0.524 (0.173-1.588) 

 

Former smoker 

18 (45.0) 

8 (20.0) 

0.233 (0.077-0.704) 

 

Smoker 

11 (27.5) 

21 (52.5) 

 

 

Smokeless Tobacco habits 

 

 

 

0.962 

Current User 

13 (32.5) 

14 (35.0) 

1.077 (0.374-3.101) 

 

Former-Users 

13 (32.5) 

12 (30.0) 

0.923 (0.314-2.716) 

 

Non-Users 

14 (35.0) 

14 (35.0) 

 

 

Alcohol drinking 

 

 

 

0.569 

Non-drinker 

16 (40.0) 

12 (30.0) 

0.525 (0.155-1.782) 

 

Current drinker 

17 (42.5) 

18 (45.0) 

0.741 (0.230-2.392) 

 

Irregular abstainer 

7 (17.5) 

10 (25.0) 

 

 

Family history of Cardiovascular disease 

 

 

 

0.485 

No 

27 (67.5) 

24 (60.0) 

 

 

Yes 

13 (32.5) 

16 (40.0) 

0.722 (0.289-1.804) 

 

Exercise regularly 

 

 

 

0.820 

No 

23 (57.5) 

24 (60.0) 

 

 

Yes 

17 (42.5) 

16 (40.0) 

1.109 (0.455-2.701) 

 

Hypertension 

 

 

 

0.000** 

No 

34 (85.0) 

19 (47.5) 

 

 

Yes 

6 (15.0) 

21 (52.5) 

0.160 (0.055-0.464) 

 

Diabetes 

 

 

 

0.431 

No 

32 (80.0) 

29 (72.5) 

 

 

Yes 

8 (20.0) 

11 (27.5) 

0.659 (0.233-1.865) 

 

Socioeconomic status 

 

 

 

0.576 

Upper 

3 (7.5) 

3 (7.5) 

0.714 (0.100-5.118) 

 

Upper middle 

19 (47.5) 

14 (35.0) 

0.526 (0.138-2.009) 

 

Lower middle 

7 (17.5) 

5 (12.5) 

0.510 (0.101-2.586) 

 

Upper lower 

6 (15.0) 

11 (27.5) 

1.310 (0.287-5.980) 

 

Lower 

5 (12.5) 

7 (17.5) 

 

 

Marital status 

 

 

 

0.388 

Married 

32 (80.0) 

27 (67.5) 

0.844 (0.111-6.397) 

 

Unmarried 

6 (15.0) 

11 (27.5) 

1.833 (0.204-16.512) 

 

Divorced 

2 (5.0) 

2 (5.0) 

 

 

Dietary habits 

 

 

 

0.003** 

Vegetarian 

34 (85.0) 

22 (55.0) 

0.216 (0.074-0.628) 

 

Mixed 

6 (15.0) 

18 (45.0) 

 

 

BMI (Kg/m2) 

24.2±3.7 

25.9±4.3 

 

0.056 

 

**P<0.01; *P<0.05 
BMI are represented as Mean±SD
Table 4 presents the association between Acute Myocardial infarction and Periodontitis, smoking habits, and dietary habits were statistically significant. Out of the total 80 patients, 40 patients are from cases in which 33 (82.5%) of cases were presented periodontitis, 7 cases (17.5%) periodontitis were absent with ( P=0.026). 21 (52.5%) of cases were Smokers,11 (27.5%) cases were non-smokers and 8 (20.0%) were former smokers with (P=0.031). 21 (52.5%) cases were presented hypertension and 19 (47.5%) cases hypertension were absent with (P=0.00) and 22 (55.0%) of cases were vegetarian and 18 (45.0%) cases were mixed with (P=0.00). There is no statistically significant association between acute myocardial infarction and tobacco habits, alcohol drinking, family history of cardiovascular disease, exercise regularly, diabetes, Socioeconomic status, marital status and BMI.

Cox Regression

The following recoding has been done to examine the association between AMI and periodontitis.
Socio economic status=0 (Reference category): Lower; 1=Upper Lower; 2=Lower middle; 3=Upper middle; 4=Upper
Family history=0 (Reference category): No; 1=Yes
Exercise=0 (Reference category): Yes; 1=No
Hyper tension=0 (Reference category): No; 1=Yes

Diabetes=0 (Reference category): No; 1=Yes

Dietary habit=0 (Reference category): Vegetarian; 1=Mixed

Smoking habit=0 (Reference category): Non-smoker; 1= Former smoker; 2=Smoker

Smokeless tobacco habit=0 (Reference category): Non-users; 1= Former user; 2=Current user

Alcohol drinking=0 (Reference category): Non-drinker; 1= Current drinker; 2=Irregular abstainer

Marital status=0 (Reference category): Unmarried; 1= Married; 2=Divorced

Block 1: 

Variables in the Equation 

 

B 

SE 

Wald 

df 

Sig. 

Exp(B) 

95.0% CI for Exp(B) 

Lower 

Upper 

Periodontitisn1 

.643 

.416 

2.388 

1 

.122 

1.902 

.842 

4.300 

 

Block 2: 

Variables in the Equation 

 

B 

SE 

Wald 

df 

Sig. 

Exp(B) 

95.0% CI for Exp(B) 

Lower 

Upper 

Periodontitisn1 

.345 

.460 

.562 

1 

.453 

1.411 

.573 

3.475 

smoking_new 

 

 

2.033 

2 

.362 

 

 

 

smoking_new(1) 

-.446 

.474 

.887 

1 

.346 

.640 

.253 

1.620 

smoking_new(2) 

.154 

.387 

.157 

1 

.692 

1.166 

.546 

2.492 

hypertension_new 

.597 

.340 

3.082 

1 

.079 

1.817 

.933 

3.540 



Block 3: 

Variables in the Equation 

 

B 

SE 

Wald 

df 

Sig. 

Exp(B) 

95.0% CI for Exp(B) 

Lower 

Upper 

Periodontitisn1 

.431 

.457 

.889 

1 

.346 

1.539 

.628 

3.772 

smoking_new 

 

 

1.278 

2 

.528 

 

 

 

smoking_new(1) 

-.418 

.474 

.777 

1 

.378 

.658 

.260 

1.667 

smoking_new(2) 

.056 

.394 

.020 

1 

.886 

1.058 

.489 

2.288 

hypertension_new 

.525 

.339 

2.397 

1 

.122 

1.690 

.870 

3.282 

diethabit_new 

-.479 

.332 

2.080 

1 

.149 

.619 

.323 

1.188 



Block 4: 

Variables in the Equation 

 

B 

SE 

Wald 

df 

Sig. 

Exp(B) 

95.0% CI for Exp(B) 

Lower 

Upper 

Periodontitisn1 

.313 

.469 

.446 

1 

.504 

1.367 

.546 

3.426 

smoking_new 

 

 

.745 

2 

.689 

 

 

 

smoking_new(1) 

-.350 

.477 

.539 

1 

.463 

.705 

.277 

1.795 

smoking_new(2) 

.017 

.406 

.002 

1 

.968 

1.017 

.459 

2.252 

hypertension_new 

.586 

.350 

2.806 

1 

.094 

1.796 

.905 

3.566 

diethabit_new 

-.502 

.338 

2.207 

1 

.137 

.605 

.312 

1.174 

BMI 

.044 

.041 

1.175 

1 

.278 

1.045 

.965 

1.131 

family_history 

.192 

.342 

.314 

1 

.575 

1.212 

.619 

2.370 



Block 5: 

Variables in the Equation 

 

B 

SE 

Wald 

df 

Sig. 

Exp(B) 

95.0% CI for Exp(B) 

Lower 

Upper 

Periodontitisn1 

.318 

.469 

.458 

1 

.498 

1.374 

.548 

3.447 

smoking_new 

 

 

.784 

2 

.676 

 

 

 

smoking_new(1) 

-.359 

.478 

.563 

1 

.453 

.699 

.274 

1.784 

smoking_new(2) 

.021 

.406 

.003 

1 

.958 

1.022 

.461 

2.263 

hypertension_new 

.596 

.353 

2.852 

1 

.091 

1.816 

.909 

3.628 

diethabit_new 

-.506 

.338 

2.240 

1 

.134 

.603 

.311 

1.169 

BMI 

.044 

.041 

1.196 

1 

.274 

1.045 

.965 

1.132 

family_history 

.189 

.343 

.304 

1 

.582 

1.208 

.617 

2.364 

diabetes_new 

-.081 

.368 

.048 

1 

.827 

.923 

.448 

1.898 



Block 6: 

Variables in the Equation 

 

B 

SE 

Wald 

df 

Sig. 

Exp(B) 

95.0% CI for Exp(B) 

Lower 

Upper 

Periodontitisn1 

.349 

.483 

.520 

1 

.471 

1.417 

.549 

3.655 

smoking_new 

 

 

.956 

2 

.620 

 

 

 

smoking_new(1) 

-.408 

.484 

.709 

1 

.400 

.665 

.258 

1.718 

smoking_new(2) 

.019 

.409 

.002 

1 

.964 

1.019 

.457 

2.271 

hypertension_new 

.599 

.358 

2.804 

1 

.094 

1.820 

.903 

3.669 

diethabit_new 

-.577 

.353 

2.670 

1 

.102 

.561 

.281 

1.122 

BMI 

.038 

.042 

.815 

1 

.367 

1.039 

.956 

1.129 

family_history 

.182 

.361 

.254 

1 

.614 

1.199 

.592 

2.431 

diabetes_new 

-.128 

.378 

.114 

1 

.735 

.880 

.420 

1.845 

tobaccohabit_new 

 

 

.491 

2 

.782 

 

 

 

tobaccohabit_new(1) 

-.306 

.438 

.488 

1 

.485 

.736 

.312 

1.738 

tobaccohabit_new(2) 

-.134 

.436 

.095 

1 

.758 

.874 

.372 

2.054 



Block 7: 

Variables in the Equation 

 

B 

SE 

Wald 

df 

Sig. 

Exp(B) 

95.0% CI for Exp(B) 

Lower 

Upper 

Periodontitisn1 

.314 

.495 

.402 

1 

.526 

1.369 

.519 

3.616 

smoking_new 

 

 

.803 

2 

.669 

 

 

 

smoking_new(1) 

-.337 

.506 

.443 

1 

.506 

.714 

.265 

1.924 

smoking_new(2) 

.089 

.427 

.044 

1 

.835 

1.093 

.474 

2.522 

hypertension_new 

.613 

.377 

2.647 

1 

.104 

1.847 

.882 

3.866 

diethabit_new 

-.590 

.358 

2.725 

1 

.099 

.554 

.275 

1.117 

BMI 

.038 

.043 

.775 

1 

.379 

1.039 

.955 

1.130 

family_history 

.094 

.378 

.062 

1 

.803 

1.099 

.524 

2.305 

diabetes_new 

-.230 

.401 

.330 

1 

.566 

.794 

.362 

1.744 

tobaccohabit_new 

 

 

.543 

2 

.762 

 

 

 

tobaccohabit_new(1) 

-.328 

.451 

.531 

1 

.466 

.720 

.298 

1.742 

tobaccohabit_new(2) 

-.132 

.452 

.086 

1 

.770 

.876 

.361 

2.124 

SES_new 

 

 

.742 

4 

.946 

 

 

 

SES_new(1) 

-.097 

.513 

.036 

1 

.850 

.908 

.332 

2.481 

SES_new(2) 

-.485 

.628 

.597 

1 

.440 

.616 

.180 

2.107 

SES_new(3) 

-.246 

.479 

.264 

1 

.607 

.782 

.306 

1.999 

SES_new(4) 

-.374 

.746 

.252 

1 

.616 

.688 

.159 

2.967 



Block 8: 

Variables in the Equation 

 

B 

SE 

Wald 

df 

Sig. 

Exp(B) 

95.0% CI for Exp(B) 

Lower 

Upper 

Periodontitisn1 

.324 

.496 

.427 

1 

.513 

1.383 

.523 

3.660 

smoking_new 

 

 

.665 

2 

.717 

 

 

 

smoking_new(1) 

-.332 

.504 

.435 

1 

.510 

.717 

.267 

1.926 

smoking_new(2) 

.055 

.435 

.016 

1 

.900 

1.056 

.450 

2.477 

hypertension_new 

.619 

.379 

2.667 

1 

.102 

1.856 

.884 

3.899 

diethabit_new 

-.626 

.372 

2.824 

1 

.093 

.535 

.258 

1.110 

BMI 

.041 

.044 

.871 

1 

.351 

1.042 

.956 

1.136 

family_history 

.103 

.380 

.074 

1 

.786 

1.109 

.526 

2.336 

diabetes_new 

-.193 

.415 

.216 

1 

.642 

.825 

.366 

1.859 

tobaccohabit_new 

 

 

.514 

2 

.774 

 

 

 

tobaccohabit_new(1) 

-.322 

.451 

.511 

1 

.475 

.725 

.300 

1.753 

tobaccohabit_new(2) 

-.149 

.453 

.108 

1 

.742 

.862 

.354 

2.095 

SES_new 

 

 

.608 

4 

.962 

 

 

 

SES_new(1) 

-.075 

.517 

.021 

1 

.885 

.928 

.337 

2.556 

SES_new(2) 

-.442 

.637 

.481 

1 

.488 

.643 

.184 

2.242 

SES_new(3) 

-.218 

.485 

.201 

1 

.654 

.804 

.311 

2.083 

SES_new(4) 

-.338 

.755 

.200 

1 

.654 

.713 

.163 

3.130 

exercise_new 

.133 

.365 

.132 

1 

.716 

1.142 

.558 

2.334 



Block 9: 

Variables in the Equation 

 

B 

SE 

Wald 

df 

Sig. 

Exp(B) 

95.0% CI for Exp(B) 

Lower 

Upper 

Periodontitisn1 

.358 

.505 

.501 

1 

.479 

1.430 

.531 

3.848 

smoking_new 

 

 

.801 

2 

.670 

 

 

 

smoking_new(1) 

-.415 

.533 

.606 

1 

.436 

.660 

.232 

1.877 

smoking_new(2) 

-.011 

.464 

.001 

1 

.981 

.989 

.398 

2.457 

hypertension_new 

.651 

.389 

2.800 

1 

.094 

1.917 

.894 

4.109 

diethabit_new 

-.680 

.389 

3.058 

1 

.080 

.507 

.236 

1.086 

BMI 

.045 

.046 

.934 

1 

.334 

1.046 

.955 

1.145 

family_history 

.098 

.383 

.065 

1 

.799 

1.103 

.521 

2.335 

diabetes_new 

-.134 

.435 

.095 

1 

.758 

.875 

.373 

2.052 

tobaccohabit_new 

 

 

.578 

2 

.749 

 

 

 

tobaccohabit_new(1) 

-.346 

.457 

.573 

1 

.449 

.708 

.289 

1.732 

tobaccohabit_new(2) 

-.153 

.453 

.115 

1 

.735 

.858 

.353 

2.084 

SES_new 

 

 

.689 

4 

.953 

 

 

 

SES_new(1) 

-.213 

.639 

.111 

1 

.739 

.808 

.231 

2.826 

SES_new(2) 

-.561 

.715 

.616 

1 

.432 

.571 

.141 

2.316 

SES_new(3) 

-.282 

.516 

.299 

1 

.585 

.754 

.274 

2.075 

SES_new(4) 

-.318 

.788 

.163 

1 

.687 

.728 

.155 

3.410 

exercise_new 

.134 

.364 

.135 

1 

.713 

1.143 

.560 

2.334 

marstatus_new 

 

 

.251 

2 

.882 

 

 

 

marstatus_new(1) 

.235 

.524 

.201 

1 

.654 

1.265 

.453 

3.532 

marstatus_new(2) 

-.030 

.926 

.001 

1 

.974 

.970 

.158 

5.960 



Dependent variable: Acute Myocardial Infarction Conditional logistic regression is for matched data. Cases are matched to controls within strata. The likelihood calculation is conditional on the strata, hence conditional logistic regression. Within each stratum, we examine the difference in the exposure variable, X, between case and control(s). If case and control(s) have the same value of X, the stratum is not informative and has no effect on the analysis. Table 5 shows the association with AMI and Periodontitis using conditional logistic regression. The analysis is conducted in multiple blocks, with confounding variables added progressively. In Block 1, AMI is associated with Periodontitis (beta=0.643, p=0.122, OR=1.902), but the association is not significant. In subsequent blocks, variables such as smoking status, hypertension, dietary habits, BMI, family history, diabetes, tobacco habits, socioeconomic status, exercise, and marital status are added, but none show significant associations (p>0.05). The odds ratios (OR) and beta values indicate higher or lower risks, but the independent variables remain insignificant across all blocks.

Conclusion

While there is a significant association between periodontitis and AMI in the case-control analysis, multivariate regression suggests that the relationship is not independent when accounting for confounding variables like smoking and hypertension. The study highlights the complex nature of AMI risk factors and the need for further research to clarify the role of periodontitis and other lifestyle factors in cardiovascular health.

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