This study compared plasma levels of established risk markers for atherosclerosis and indices of inflammation in 50 patients with severe periodontitis to those in 46 healthy cases.Full blood counts were performed and levels of high density lipoproteins (HDL), total cholesterol, haptoglobin, elastase, C-reactive protein (CRP), IL-6, TNFalpha receptor-1, alpha-1-antitrypsin and antibodies against human heat shock protein (Hsp) 60, mycobacterial Hsp65 and oxLDL were determined. Total cholesterol levels were similar in both groups, whereas HDL levels were lower (P=0.007) and the lipid profile (total cholesterol/HDL) was consequentially higher (P=0.03) in patients. Monocyte counts were elevated (0.56 vs 0.44x10(9)/l; P=0.002) and CRP levels were higher in patients, but TNFalpha receptor-1 and elastase levels were not. Anti-oxLDL antibody levels were similar, as were levels of haptoglobin, IgG anti HSP60, IgA and IgG anti-Hsp65 antibodies. Levels of IgA anti-Hsp60 antibodies were lower in patients (P=0.0001). Logistic regression analysis revealed a relationship between periodontitis and HDL (OR 2.15/0.5mmol/l, P=0.02) and body mass index (OR 4.54 P=0.005).Serological differences in subjects with periodontitis, some of which involve established risk factors for atherosclerosis, might provide insight into the reported epidemiological association between periodontitis and cardiovascular disease.