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Bad teeth and myocardial infarction. Roles for white cells and fibrinogen.

EDITOR,-Frank DeStefano and colleagues report an increased risk of coronary heart disease and mortality in men with dental disease. ' There is evidence that immunocompetent cells have a role in initiating and accelerating the development of atherosclerosis and myocardial infarction. In particular, activated macrophages are considered to play a pivotal part. Increased serum concentrations of neopterin are found in patients with atherosclerosis,2 and in a community based study neopterin was the best single predictor of atherosclerosis-even better than more classic variables like cholesterol, low density lipoprotein, and high density lipoprotein.3 Large amounts of neopterin are released from human macrophages on stimulation with interferon y. Increased serum neopterin concentrations have been found in patients with infectious syndromes, malignancies, and autoimmune diseases.4 Interestingly, among blood donors a substantial proportion with a raised serum neopterin concentration presented with dental diseases.' These data indicate that dental diseases may often lead to chronic activation of the immune system, which may render patients more susceptible to atherogenesis, thus increasing the risk of myocardial infarction. It would be interesting to learn from DeStefano and colleagues whether variables of immune activation are more commonly increased in their patients with dental disease and with increased risk of myocardial infarction.