title: Fluoride in the drinking water and the geographical variation of coronary heart disease in Finland.
abstract: BACKGROUND
  Fluoride in drinking water prevents dental disease, which in turn has been reported to increase the risk of coronary heart disease (CHD). Since mortality from CHD in Finland is high in the north-east where the fluoride content of drinking water is low, the association was examined here in more detail.
  
  
  METHODS
  Mortality from CHD during the period 1961-1995 in 365 rural areas of Finland (188 888 deaths) was linked with 2131 drinking water fluoride determinations performed in 1958 using negative binomial regression, adjustments being made for sex, age, mean income of the resident commune and drinking water magnesium and calcium.
  
  
  RESULTS
  An inverse J-shaped relationship was found between drinking water fluoride and CHD, the association being most pronounced in the 1960s and levelling off consistently as a function of time. In 1961-1970, the adjusted mortality from CHD was 22% (95% confidence interval 18-27%) lower in the fourth quintile of fluoride (0.15-0.30 mg/l) than in the first quintile (0.00-0.06 mg/l) but this deficit reduced to 13% (7-18%) in 1991-1995.
  
  
  CONCLUSIONS
  Although causality cannot be asserted, the geographical pattern of CHD in Finland is consistent with the concentration of fluoride in drinking water. One mechanism could be that fluoride prevents dental infections, which in turn reduces mortality from CHD. The more widespread use of fluoridated toothpastes, soft drinks and certain food items since the 1960s may have reduced the significance of drinking water as a source of fluoride.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland. juhana.kaipio@hus.fi
authors.forename: Juhana
authors.initials: J
authors.lastname: Kaipio
authors.forename: Simo
authors.initials: S
authors.lastname: Näyhä
authors.forename: Ville
authors.initials: V
authors.lastname: Valtonen
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000008:administration & dosage; D002327:Cariostatic Agents / Q000008:administration & dosage*; D003327:Coronary Disease / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D004326:Drinking / Q000187:drug effects*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005459:Fluorides / Q000008:administration & dosage*; D005843:Geography; D006801:Humans; D008274:Magnesium / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012423:Rural Health; D013223:Statistics as Topic
chemical_list: D002327:Cariostatic Agents; D008274:Magnesium; D005459:Fluorides; D002118:Calcium