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INTRODUCTION: Numerous studies have demonstrated an association between oral health status and systemic diseases. However, reports examining apical periodontitis (AP) and cardiovascular disease (CVD) are few. This study investigates whether an association exists between AP and CVD. METHODS: The present study was a pair-matched, cross-sectional design that used medical and dental chart review. The AP group (n = 182) was defined as subjects with radiographic AP, and the non-AP group (n = 182) was defined as subjects without any radiographic AP. Samples for both groups were pair-matched by age and gender. Diagnosis for CVD, hypercholesterolemia, hypertension, and diabetes were identified by using International Classification of Diseases, Ninth Revision, Clinical Modification and collected from electronic medical records. Documentation of alcohol use, smoking, race, and body mass index within the electronic medical records was also collected. Presence or absence of AP, missing teeth, teeth with root canal treatment, caries experience, and history of periodontal disease were collected from the electronic dental records. Analysis was performed by using Pearson chi2, the paired t test, and conditional multivariate logistic regression. RESULTS: AP was significantly associated with CVD, hypercholesterolemia, race, missing teeth, caries experience, and number of root canal treatments in our bivariate analysis. Our final adjusted conditional logistic regression model showed statistically significant positive associations between AP and CVD (odds ratio, 5.3; 95% confidence interval, 1.5-18.4). CONCLUSIONS: Subjects with AP were more likely to have CVD than subjects without AP by 5.3-fold. However, further research is needed to elucidate temporality and reinforce association between CVD and AP.