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Abstract
Cardiovascular disease (CVD) is Irelands greatest killer with almost 10,000 people dying every year from conditions such as coronary heart disease and congestive cardiac failure (heart failure); cerebral (brain) conditions such as stroke; and peripheral (limb) conditions such as peripheral vascular disease. The main base cause of heart disease is atherosclerosis whereby blood vessels narrow or become completely blocked. Mortality rates from CVD increased sharply after commencement of water fluoridation in Ireland and peaked when all major urban areas and the majority of the population were fluoridated in the mid 1970s. Today Ireland continues to have the highest rate of premature deaths from ischaemic heart disease (<65yrs) in the European Union and life expectancy for both men and women ranks below the EU 15 average life expectancy. Research has demonstrated that fluoride is a risk factor in cardiovascular disease, as well as other major diseases including hypothyroidism, diabetes and obesity. Fluoride interferes with heart function, incorporates into the aorta and atherosclerotic plaque in coronary arteries as well as impairs homocysteine, insulin and glucose synthesis. Research has demonstrated that oxidative stress and inflammation are important pathophysiological mechanisms involved during ischaemic stroke. Fluoride is recognized to contribute to oxidative stress and inflammation. Coronary heart disease has been found to be strongly associated with dental fluorosis (a biomarker for chronic overexposure to fluoride). Ireland has the highest prevalence of dental fluorosis in the EU and is also the only EU Member State to support mass intoxication of its population with fluoride and silicofluorides through public water supplies. The recent epidemic of diabetes and obesity in Ireland and their future contribution to cardiovascular illhealth will place further enormous social and economic burdens on the Irish state. In light of these findings it is critical that risk factors such as fluoride exposure are urgently reassessed and mass medication without informed consent of populations through artificial fluoridation of water is ended to protect public health.
Introduction
Cardiovascular disease remains the most common cause of death in Ireland, currently accounting for one-third of all deaths and one in five premature deaths. Vascular diseases, of which cardiovascular disease is the most common, account for over 40% of all deaths and 37% of deaths under 65 years in Ireland. Approximately 10,000 people die each year in Ireland from cardiovascular disease (CVD) including coronary heart disease (CHD), stroke and other circulatory
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disease. The largest number of these deaths relate to CHD - mainly heart attack - at 5,000, with approximately 22% of premature deaths (under age 65) due to CVD. According to figures from the cardiac rehabilitation unit at Wexford General Hospital, the number of deaths from Coronary Artery Disease in Ireland is 60,7 per 100,000, almost twice the EU average of 32.6.
As is evident in the graph, a sharp increase in mortality occurred in 1967 and continued to rise significantly above European averages until 1978, when levels reached plateaued out and from where they eventually started to decline. While deaths rates have declined since from 2000-2004 Ireland had on average 144 deaths from CHD per 100,000 population, which was higher than EU 15 of 92 deaths per 100,000 and higher than the EU 27 of 113 deaths per 100,000. The major decline has been in the past decade brought about largely by increased clinical intervention, medication and behavioral change. It has been estimated that half of the decrease in death rates can be attributed to treatments and interventions.7 The latter however has not had a major affect on the number of adults smoking which still remains alarmingly high at 29%.8 If it were not for fluoridation, it is most likely that mortality rates would have levelled off earlier and not have risen to the record levels attained in the 1970s.
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EU15 data refers to 9 countries in 2007 and 12 in 2006 who had reported mortality data. 2 EU27 data refers to 19 countries in 2007 and 23 in 2006 who had reported mortality data.
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Case Study on Implications for Public Health in Ireland Geographic Variation in CHD
There is a wide geographic variation in mortality rates from cardiovascular disease in Ireland. This is illustrated in Figure 3 below. The incidence rates do not include undiagnosed CHD.
The geographic spread for CHD largely mirrors that for other major diseases in Ireland such as diabetes, cancer and neurological illness. The areas with the highest prevalence of disease burdens are largely those where drinking water is both soft (low in calcium) and fluoridated.17 It is interesting to note that the most Southerly part of Ireland has the highest incidence of CHD. Drinking water in large parts of South and South East Ireland including West Cork located in the southern tip of (the area identify as red on the map above) Ireland, are extremely soft with less than 20mg/L Calcium. Similarly soft water is found in large parts of geographic areas such as Mayo, Donegal, Kerry, Wexford, Waterford and Roscommon. All counties with elevated CHD significantly above the European average.
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Case Study on Implications for Public Health in Ireland Comparison with Northern Ireland and Europe
According to figures from the cardiac rehabilitation unit, Wexford General Hospital, the number of deaths from Coronary Artery Disease in Ireland is 60,7 per 100,000, almost twice the EU average of 32.6. In comparison the age standardized death rate from CHD in Northern Ireland is 60.44 for men and women 21.01. However it must be noted that poverty, stress and social conflict play a major role in heart disease and this is reflected for the data for NI. Significantly higher CHD prevalence is noted in the geographic areas with the highest social inequality, poverty and unemployment. These same areas not only represent those that are the most socially deprived but also where conflict and trauma were most prevalent during the Troubles in Northern Ireland. For example significantly higher CHD rates for males are to be found in Derry (80.09), Belfast.(89.05) and Ballymena (115.45) compared to more rural areas such as Castlereagh (30.08) Antrim (24.9) and Moyle (33.48).18 What is also remarkable about the data for Northern Ireland is that the only two locations in Northern Ireland where fluoridation was introduced and continued for approximately 30 years, in Tandragee Co. Armagh and Hollywood, County Down, both had significantly higher rates of premature mortaility compared to the their adjoining local authority districts.19 In comparing CHD in Ireland with Europe the Age-standardized Disability-adjusted life years (DALYs) per 100,000 for CHD, stroke and other CVD, provides further insights to the impact of CHD and the gap between Ireland and other European Member
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Confounding Factors:
There are many compounding factors in CHD, some of these are discussed in the following section with comparisons where appropriate between Ireland with other EU Member States.
Influence of Smoking
Tobacco, like tea is a significant source of fluoride and is a major source of dietary fluoride intake. In Europe, about 20% of deaths from CVD in men and about 3% of deaths from CVD in women are due to smoking. The equivalent figures for the 25 countries that made up the EU in 2006 (EU-25) are 16% and 5% respectively. For the period 1995-99 Ireland had one of the lowest prevalence of smoking for adults in EU at 32.4 percent, compared to France 35, Germany 43, Denmark 35.4,Italy 33.8,Norway 33.4,the Netherlands 38.9,Spain 42.8 and Switzerland 39.21 Based on these figures the difference between CHD rates for Ireland and other European countries should be considerable less, as historically higher smoking prevalence in other European Member States should see a marked increase in CHD mortality rates from smoking compared to Ireland. Yet this is not the case. It is evident therefore that while smoking is contributing to CHD amongst the population additional factors are influencing the significantly higher burden of CHD present in Ireland.
Vitamin D 12
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It is likely that V D12 is playing a role in increased CHD in Ireland but these figures would suggest that it is limited and other factors dominate.
Homocysteine
There are a number of risk factors associated with cardiovascular disease including homecysteine.39,40,41 Homocysteine is an intermediate product of methionine metabolism. Any substance that may inhibit secondary metabolism of methionine would result in increased homocysteine levels resulting from less homocysteine being metabolized into (L)-Cystathionine. Fluoride is known to be an inhibitor of enzymatic activity and research has identified fluoride as an inhibitor of homocysteine hydrolase.42 Inhibition of homocysteine hydrolase would result in cellular accumulation of homocysteine43 and therefore contribute to the development of cardiovascular disease. The impact of fluoride on homocysteine must consequently to be considered a risk factor in the high rates of CHD in Ireland.
Researchers Menoyo et al.32 and Lin et al.33 demonstrated the effect of fluoride on glucose metabolism using in vivo and in vitro experimental models and confirmed that biologically relevant doses of fluoride result in impairment of an oral glucose tolerance test and decreased insulin synthesis. It has also been reported that fluoride exposure regulates insulin gene expression in murine beta pancreatic cells, resulting in reduced insulin secretion.34 Further studies have shown that fluoride exposure may contribute to impaired glucose tolerance or increased blood glucose.35,36,37
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Case Study on Implications for Public Health in Ireland Fluoride and Heart Physiology
Research published in 2010 demonstrated that fluoride also affects the aorta (main artery) and heart in ways that lead to increased heart attacks. 44,45 This confirms earlier studies showing that high bloodfluoride levels have an effect on body calcium, leading to calcification of the aorta and other arteries.46,47 Varol et al. examined the effect of fluoride exposure on cardiovascular system in a clinical setting. and observed that elastic properties of ascending aorta were impaired in patients with endemic chronic fluorosis and that chronic fluoride toxicity can cause aortic stiffness in patients as well as ventricular diastolic and global dysfunctions.48,49 Furthermore Varol et al found that fluoride toxicity can cause atherosclerosis at molecular level, as well as aortic stiffness and disturbed ventricular distensibility at clinical level. 50 Research has also demonstrated that fluoride accumulates in aorta vascular walls and that a significant correlation exists between fluoride uptake and coronary calcifiation.51 Further research has shown that the heart beat rate slows, and heart rate abnormalities increase, in direct proportion to increasing fluoride levels. Since fluoride is a cumulative poison, lower levels of fluoride will have a more subtle long-term effect, thus increasing heart problems and other disease burdens in society Due to the that fact that fluoride bioaccumulates in the human body over a lifetime even relatively low levels of used for water fluoridation, taken in additon to other dietary sources of fluoride the burden or toxic affect can
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This supports the findings from the earliest days of fluoridation in the USA which found that following the introduction of fluoridation, deaths from heart attacks significantly increased in fluoridated communities, compared to the non-fluoridated communities.54,55, 56
The data from the USA has appears to collerate with CHD data for the England where it can be seen that the highest prevalance of CHD is geographically located in areas where water fluoridation programmes are currently in use It has also been documented by Professor T. Takamori and his researchers in Japan that fluoride damages the heart muscle, especially in subjects deficient in Vitamins A and D.57 They further observed that fluoride decreases the energy building glycogen in the muscles,58 and, that it adversely affects the functions of the kidneys.59
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Inflammatory Response
Fluoride exposure has been implicated in inflammation. Inflammation is the first response of the immune system to infection or tissue damage, leading to the protection of the human body against these insults. As noted in the review by Barbier et al65 chronic inflammation is harmful and has an important role in the development of several chronic diseases such as diabetes and atherosclerosis, both of which contribute significantly to CHD. The review further discusses how fluoride contributes to inflammatory processes that may play a significant role in cardiovascular disorders and recommends more research be
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Oxidative Stress
Oxidative stress is a recognized mode of fluoride action.75 Oxidative stress is also related to the pathogenesis of many chronic disorders including cancer, inflammation, and neurological diseases.76 Researchers Varol et al. reported, that in addition to fluoride exposure causing oxidative stress, it may have an important role in cardiovascular disease. 77 He also observed that in addition to promoting inflammatory mechanisms, oxidative stress contributes to atherosclerosis, vascular stiffness, and myocardial cell damage. Researchers have also found that oxidative stress and inflammation are important pathophysiological mechanisms involved during ischemic stroke.78,79 In addition endothelial dysfunction and vascular disorders have been associated with fluoride exposure in humans.80,81 According to Barbier et al. 82 the data suggest an important role played by factors related to oxidative stress and vascular inflammation, providing future
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Concluding Remarks
The distinguished scientist Dr. Schatz believed that fluoridation of drinking water is not safe at any level and believed that artificial fluoridation of drinking water may well dwarf the thalidomide tragedy, which was dramatic because it produced crippled children who are living testimonials to what that drug has done. Many victims of artificial fluoridation, on the other hand, die quietly during the first year of their lives, or at a later age under conditions where their deaths are attributed to some other cause.106 Furthermore Dr. Schatz stated: (b)ecause artificial fluoridation causes deaths among individuals who are for one reason or another more sensitive to fluoride toxicity than the total population taken as a whole, the controversy over whether fluoridation does or does not reduce caries is purely academic. It is criminal to implement a so-called public health measure which kills certain people even if it does reduce tooth decay in some of the survivors.
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