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See Also: My letter to the Trump Administration Re: EPAs Involvement in Water Fluoridation

By Stuart Cooper
Campaign Director, Fluoride Action Network

The Fluoride Action Network (FAN), along with a coalition of environmental and public health groups has filed a complaint in the U.S. District Court for the Northern District of California against the U.S. Environmental Protection Agency (EPA) in response to their denial of our petition under Section 21 of the Toxic Substances Control Act (TSCA) seeking a ban on water fluoridation.

We believe this lawsuit is an unprecedented opportunity to end the practice once and for all in the U.S., and potentially throughout the world, based on the well-documented neurotoxicity of fluoride. You may read the official complaint here. According to FAN’s attorney and adviser, Michael Connett:

“This case will present the first time a court will consider the neurotoxicity of fluoride and the question of whether fluoridation presents an unreasonable risk under the Toxic Substances Control Act (TSCA).

And, in contrast to most other legal challenges of Agency actions, TSCA gives us the right to get the federal court to consider our evidence ‘de novo’ — meaning federal courts are to conduct their own independent review of the evidence without deference to the EPA’s judgment.”

Industry, legal and environmental observers following the EPA’s implementation of the new TSCA law have pointed out that a lawsuit1challenging the EPA’s denial of our petition would provide a test case for the agency’s interpretation that petitioners must provide a comprehensive analysis of all uses of a chemical in order to seek a restriction on a particular use.

Legal experts have suggested the EPA’s interpretation essentially makes the requirements for gaining Agency action using section 21 petitions impossible to meet, making the outcome significant for all U.S. residents and public health or environmental watchdog groups.

Lawsuit Background: EPA Served With Citizen’s Petition

On November 22, 2016, a coalition including FAN, Food & Water Watch, Organic Consumers Association, American Academy of Environmental Medicine, International Academy of Oral Medicine and Toxicology, Moms Against Fluoridation and several individual mothers, filed a petition calling on the EPA to ban the deliberate addition of fluoridating chemicals to the drinking water under provisions in the Toxic Substances Control Act (TSCA).

The petition includes more than 2,500 pages of scientific documentation detailing the risks of water fluoridation to human health.The full petition can be accessed here, a shorter eight-page summary here and our press release here.

We presented the FDA with a large body of human and animal evidence demonstrating that fluoride is a neurotoxin at levels now ingested by many U.S. children and vulnerable populations. We also presented the agency with evidence showing that fluoride has little benefit when swallowed and, accordingly, any risks from exposing people to fluoride chemicals in water are unnecessary.

We believe an impartial judge reviewing this evidence will agree that fluoridation poses an unreasonable risk. On February 27, 2017, the EPA published their response.2 In their decision, the EPA claimed:

“The petition has not set forth a scientifically defensible basis to conclude that any persons have suffered neurotoxic harm as a result of exposure to fluoride in the U.S. through the purposeful addition of fluoridation chemicals to drinking water or otherwise from fluoride exposure in the U.S.”

As many independent scientists now recognize, fluoride is a neurotoxin.3 The question, therefore, is not if fluoride damages the brain, but at what dose. While EPA quibbles with the methodology of some of these studies, to dismiss and ignore these studies in their entirety for methodological imperfections is exceptionally cavalier, particularly given the consistency of the findings and the razor-thin margin between the doses causing harm in these studies and the doses that millions of Americans now receive.

EPA’s own Guidelines for Neurotoxicity Risk Assessment highlights the importance of having a robust margin between the doses of a chemical that cause neurotoxic effects and the doses that humans receive. FAN presented the EPA with over 180 studies showing that fluoride causes neurotoxic harm (e.g., reduced IQ), pointing out that many of these studies found harm at levels within the range, or precariously close to, the levels millions of American children now receive.

Typically, this would be a cause for major concern. But, unfortunately, the EPA has consistently shied away from applying the normal rules of risk assessment to fluoride — and it has unfortunately continued that tradition with its dismissal of our petition.

Fortunately, the TSCA statute provides citizens with the ability to challenge an EPA denial in federal court. For too long, EPA has let politics trump science on the fluoride issue (see examples). FAN welcomes having these issues considered by a federal court, where scientific evidence has a better chance of being weighed objectively.

To accompany our lawsuit, FAN is offering a new DVD and a comprehensive campaign flash drive package. The DVD features the video, “Fluoride and the Brain,” in which Michael Connett explains that fluoride’s ability to lower IQ in children is just the tip of an iceberg of over 300 animal and human studies that indicate that fluoride is neurotoxic.

We have also made a comprehensive collection of campaign and educational videos available on a single flash drive for a limited time. It also includes our EPA petition and supporting documentation. This is a must-have for every fluoride-free campaigner’s toolkit.4  Another must-have is the book “The Case Against Fluoride,” by environmental chemist and toxicologist Paul Connett, Ph.D., which contains a comprehensive science-based argument for the end to artificial water fluoridation.

Winning this lawsuit will require a full team effort, and we want you to feel a part of that team and a part of this moment in history. Please consider playing a larger role in this potentially fluoridation-ending lawsuit by making a tax-deductible contribution.

New Study Quantifies Fluoride’s Potential to Lower IQ in Children

Since submitting our citizen’s petition to the EPA, we have learned even more about the threat to the next generation. Some children in the U.S. may be consuming enough fluoridated water to reach doses of fluoride that have the potential to lower their IQ, according to a research team headed by William Hirzy, Ph.D., a former senior scientist at the EPA who specialized in risk assessment and published an important risk analysis in the journal Fluoride last year.5

Current federal guidelines encourage the addition of fluoride chemicals into water supplies to reach 0.7 milligrams per liter (mg/L). Hirzy followed EPA risk assessment guidelines to report: “The effect of fluoride on IQ is quite large, with a predicted mean 5 IQ point loss when going from a dose of 0.5 mg/F/day to 2.0 mg F/day.”

Many children in the U.S. commonly consume these levels of fluoride within this range from all sources (i.e., water, food, dental products, medicines and air pollution). Hirzy explains the significance of this study:

“The significance of this peer reviewed risk analysis is that it indicates there may be no actual safe level of exposure to fluoride. Groups of children with lower exposures to fluoride were compared with groups having higher exposures. Those with higher exposures performed more poorly on IQ tests than those with lower exposures.

One well-conducted Chinese study indicated that children exposed to 1.4 mg/day had their IQ lowered by 5 IQ points. Current average mean daily intakes among children in the United States are estimated by EPA to range from about 0.80 mg/day to 1.65 mg/day. Fluoride may be similar to lead and mercury in having no threshold below which exposures may be considered safe.”

Dr. Bill Osmunson, FAN’s interim director, noted that this risk analysis adds further weight to the petition submitted to the EPA by FAN and other groups in November to ban the addition of fluoride chemicals to drinking water under provisions in the Toxic Substances Control Act.

FAN’s Persistence Pays Off: US Government Funding Neurotoxicity Studies

FAN progress isn’t limited to the legal world. Our relentless effort to get the U.S. government to take fluoride’s neurotoxicity seriously is also beginning to pay off in other ways. For many years, American regulatory and research agencies have failed to finance studies seeking to reproduce the many studies undertaken abroad that have found harm to the brain (over 300).

When toxicologist and pharmacologist Phyllis Mullenix, et al., published their groundbreaking animal study6 on fluoride and animal behavior in 1995, she was fired from her position as chair of the toxicology department at the Forsythe Dental Center. That sent a chilling message to U.S. researchers — research on fluoride toxicity is a “no-go” area. But that is changing. Now, with the U.S. government funding several important toxicology studies, this should encourage other Western researchers to get involved:

There is a new National Institutes of Health (NIH) funded fluoride/brain study.7 Our Canadian friends are extremely excited by this research funding to Christine Till and Ashley Malin, the co-authors of the important study that found a correlation between fluoridation and increased ADHD rates in the U.S.8 This could definitely be one of the most important developments in water fluoridation to date.

The National Toxicology Program (NTP) is in the process of completing a rodent study using low levels of fluoride exposure. However, we have concerns over the consultation process NTP had prior to when this study was undertaken (see “Vigilance Still Needed” at end of this article).

Dr. Philippe Grandjean, Harvard School of Public Health, is leading an ongoing study of fluoride and intelligence among a group of schoolchildren in China. Grandjean published the preliminary results of this study in the January-February 2015 issue of Neurotoxicology & Teratology.9

A National Institute of Environmental Health (NIEHS)-funded human epidemiological study titled “Prenatal and Childhood Exposure to Fluoride and Neurodevelopment” is investigating the relationship between fluoride and IQ among a cohort of children in Mexico. A summary of the study10 is available online.

An NIEHS-funded animal study, “Effects of Fluoride on Behavior in Genetically Diverse Mouse Models,” is investigating fluoride’s effects on behavior and whether these effects differ based on the genetic strain of the mouse. The principal investigator of the study is Dr. Pamela Den Besten. A summary of her study11 is available online.

The NIH is funding a study investigating the impact of fluoride on the timing of puberty among children in Mexico. This study is pertinent to the assessment of fluoride’s impact on the pineal gland’s regulation of melatonin. The preliminary results of the study were presented at the 2014 Independent School Entrance Examination ISEE conference and can be accessed online.12

Though not funded by the U.S. government, Jaqueline Calderón Hernandez, Ph.D., Universidad Autónoma de San Luis Potosí, Mexico, is currently working with Diana Rocha-Amador, Ph.D., on three studies on fluoride neurotoxicity:

1.An examination of the cognitive effects from fluoride in drinking water

2.Estimating the global burden of disease of mild mental retardation associated with environmental fluoride exposure

3.Investigating the impact of in utero exposure to fluoride (via drinking water) on cognitive development delay in children

Rocha-Amador is also examining the impact of fluoride on thyroid hormone levels in pregnant women, and published a fluoride/IQ study in 2007.13

Vigilance Still Needed

We still have to be vigilant to make sure that those determined to protect the fluoridation program don’t skew the results. For example, it is worrying that the NTP specified that an animal study should be conducted at 0.7 ppm — which is a ridiculous provision for an animal study on fluoride. For example, it is well-known that rats need a much higher dose of fluoride in their water to reach the same plasma levels in humans.

Moreover, it is standard practice in toxicology to use much higher doses in animals to tease out effects. To conduct experiments on animals at expected human doses would require a huge number of animals, which would be cost prohibitive. These studies also raise a significant question for those who continue to promote fluoridation in local communities and legislatures around the world.

“What primary scientific studies (not bogus reviews conducted by pro-fluoridation agencies) can you cite that give you the confidence to ignore or dismiss the evidence that fluoride damages the brain as documented in over 300 animal and human studies (including 50 IQ studies)?”

As shown by its support for these new neurotoxicity studies, our own government has acknowledged the risk fluoride poses to our children. If proponents cannot provide an adequate scientific answer to this question, then fluoridation should be halted immediately, and should under no circumstances be initiated.

National Fluoridation Stats Show Tipping Point Has Been Reached

Progress is also being made on the political front. U.S. Center for Disease Control (CDC) fluoridation statistics for the U.S. have been released for 2014,14 and they show exactly why the fluoridation lobby has been pouring more money and resources into promoting the practice and fighting our efforts: WE ARE WINNING!

For the first time in nearly 40 years, the percentage of the U.S. population served by community water systems receiving fluoridated water decreased, from 74.6 percent to 74.4 percent. The percentage of the U.S. population receiving optimally fluoridated water (natural and artificial) also decreased, from 67.1 percent to 66.3 percent. Also decreasing:

  • The number of water systems providing fluoridated water (natural or artificial)
  • The number of water systems adding fluoride
  • The number of water systems providing naturally “optimal fluoride” levels

Momentum Continues to Build Thanks to Citizens Like You

More than 460 communities throughout the world have ended existing fluoridation programs or rejected new efforts to fluoridate either by council vote or citizen referendum since 1990. Since January 2016 alone, we’ve confirmed that at least 33 communities with nearly a million collective residents voted to end fluoridation, bringing the number of victories since 2010 to at least 225 communities,15 representing approximately 6.5 million people.

Most of these victories were the result of citizens organizing local campaigns and voicing their opposition to public officials, with many working in coordination with FAN or using our materials to educate their neighbors and local decision makers about the serious health risks associated with the practice. Some of the latest victories in the U.S. and abroad include:16

Dear Durham Against Fluoride Readers,

This is an urgent message concerning the public water fluoridation program in the Triangle area.  We NEED YOU to sign this petition (whether you live in Orange County or not). This will be presented to the local Orange Water and Sewer Authority board this coming THURSDAY MARCH 23, 2017 to immediately stop all actions to resume public water fluoridation in the wake of the recent public health crisis this past February.

CLICK HERE TO SIGN PETITION AGAINST WATER FLUORIDATION IN CHAPEL HILL / CARRBORO 

To recap, here is an abbreviated  chronology of events, many of which can be found in video form on this website:

  • In 2012, citizens first put OWASA on notice that public water fluoridation is wrought with legal, ethical, medicinal, and practical problems and should be stopped immediately.
  • December of that year OWASA organized a slanted, closed panel of “experts” who were both PRO-Fluoride which lead them to vote on continuing the practice
  • In 2013, additional petitions were filed over the course of many months to legitimately examine the issue, while OWASA attempted to “deal” with such citizens without formally addressing the issue.
  • In the summer of 2013 OWASA voted AGAIN to continue public water fluoridation and encouraged us to consult with the county commissioners if they were so inclined to change the policy.
  • In 2014, we did just that and found an equally bureaucratic and non-critical examination of the facts.  The county health director and county commissioners did nothing & fluoridation continued.
  • In February of 2017 OWASA “accidentally” set the fluoride feed pumps to 8X the normal pump speed and left them on for 3.5 hours.  When it was discovered, the water treatment plant was shut down, and subsequently a water main broke which left the community without safe running water for 2 days.
  • Later that month, OWASA heard from citizens concerning the water disaster, and a full 90% of the respondents including two former board members were in staunch opposition to the public water fluoridation program.  OWASA did not address any concern specifically as they wanted the water disaster and the fluoridation issue to be considered in a mutually exclusive vacuum.
  • The next OWASA meeting with public comment, even more citizens arrived to speak against public water fluoridation and OWASA’s negligence, but OWASA still would not address the issue head on and reserved the right to “examine or not examine it.”  In the same meeting, OWASA admitted Fluoride binds to lead and enters the water system and voted unanimously against my petition for a public referendum on the public fluoridation issue.
  • Then, OWASA held an impromptu meeting at their community room where they would decide “if we would examine, or not examine the public water fluoridation issue again.”  The UNC dental school was obviously commissioned and sent a bunch of their lackey’s including Rebecca King who testified in Durham & Chapel Hill on behalf of the Oral Health Section of the Department of Health and Human Services back in 2012 to promote Fluoridation, but was fired by DHHS in 2013.  Citizens suspect OWASA contacted the dental school because they were losing the argument at every meeting both in numbers and in logic.
  • OWASA then voted AGAIN to resume “normal” fluoridation protocols despite majority public sentiment in opposition.
  • OWASA is holding a meeting on the 23rd of March where they will announced their planned date to “resume fluoridation” ostensibly after they have “fixed” the issues which lead to over-fluoridation in the first place.

By Corey Sturmer

In the wake of a water utility disaster which involved the Orange Water and Sewer Authority “accidentally” over-fluoridating the public water supply, OWASA is holding a series of meetings to discuss the emergency and hear from concerned citizens regarding the incident. At the first public comment section which took place February 9, the majority of citizens who took time to speak focused narrowly on OWASA’s longstanding public water fluoridation policy and demanded it’s immediate cessation. OWASA had been warned about the dangers as far back as 2012, but persisted in their march to fluoridate leading up to the disaster. OWASA has actually already suspended the public water fluoridation program after the ‘accident’ but then brought in an alleged “Independent Consultant” who was tasked with delivering a report on the infrastructure failures and ways to improve. The consultant is CH2M Hill, which is a multi-billion dollar government trough company with negative revenue who also happens to have a conflict of interest in this matter since they contract with the very same fertilizer companies who produce and sell fluoride across the United States. Not surprisingly, CH2M Hill is being even less critical of the fluoridation policy than OWASA and it seems apparent that the Town of Chapel Hill will continue the policy if the citizens don’t speak up. In the 2nd public comment meeting on this topic, OWASA accomplished the following things;

1) Admitted that Fluoride causes leaching from lead pipes / joints / fixtures

2) Admitted that OWASA is not mandated to fluoridate

3) Admitted by omission that OWASA customers never voted to fluoridate

4) Admitted that there is no barrier between the fluoridation clearwell and the distribution system

5) Admitted that they will allow over-fluoridation in the future as a cost-benefit to prevent having to cut off the water

6) Voted unanimously against allowing the OWASA customers to have a public referendum on public water fluoridation. As you can see, OWASA is a corrupted and compromised institution that does not have the public’s best interest at heart.

You can contact the OWASA Board here: http://www.owasa.org/board-of-directors

And support our efforts here: https://www.gofundme.com/DurhamAgains…http://www.durhamagainstfluoride.com

In this unprecedented special report from DurhamAgainstFluoride.com, we officially launch our investigation to discover just what exactly the City of Durham has been doing to our tap water.

With the ongoing fracking controversy, recent chemical spill in West Virginia & now the third largest coal ash spill in North Carolina history, water quality concerns should be top of mind for every American citizen in 2014.

That is why we decided to use some of the donations our effort has accumulated to commission an independent analysis of the residual sludge left after more than 7 months of distilling the city of Durham’s municipal tap water.  We are employing the National Testing Laboratories to evaluate a sample of the liquid depicted in the video above.

For more details on what this test will be trying to determine, click here.

Our special report also explains how distillation is the ultimate method of water purification, guaranteed to remove 100% of the fluoride & other toxins that are contaminating our public tap water.

Did you just learn about fluoride & want the only method guaranteed to remove it? You’ve come to the right spot.

Stay tuned on DurhamAgainstFluoride.com for updates as we receive these revealing results from the National Testing Laboratories & report on our findings.

Visit: http://www.durhamagainstfluoride.com

Friend us: http://www.facebook.com/durhamagainstfluoride

widget

Thanks to a new understanding of water filtration techniques, I have created a brand new page on the top menu bar of DurhamAgainstFluoride which is designed to educate & enable you to protect yourself against the harmful chemicals and medications deliberately added to your municipal tap water.

It is also a very easy and seamless way for you to support my effort to expose the bureaucrats who toxify our water in the first place, since you are able to purchase a home water distiller here which will also contribute $49.00 to our cause and will thus help us pay for this website, flyers and other material to help raise awareness on public water fluoridation.

Check it out today! – “How to Remove Fluoride”

Source: News & Observer

By Jane Porter — jporter@newsobserver.com

A practice that most North Carolinians do without thinking much about it – drinking fluoridated water from local systems – has become a controversial topic in parts of the Triangle.

On Thursday, the Orange County Water and Sewer Authority will hear petitions from citizens who want the county to stop fluoridating public water. And in Durham on Thursday, Board of Health directors will hear from a subcommittee that was asked to look into the issue.

Fluoride opponents point to a book, “The Case Against Fluoride,” to support their argument that fluoridating drinking water amounts to adding hazardous waste to the public water supply. They say fluoride is potentially hazardous to human health and is not as beneficial in preventing tooth decay as once thought.

Nearly 90 percent of North Carolina residents who drink from local water systems drink fluoridated water. It has been standard practice in most North Carolina counties for 50 years.

But after some Durham residents complained, the county’s Board of Health assembled a subcommittee in March “to evaluate the addition of fluoride to city drinking water and come back with a recommendation,” said Vicki Westbrook, the city’s assistant director of water management. The board is expected to hear the subcommittee’s recommendation at a meeting Thursday.

Corey Sturmer, a Durham citizen who opposes water fluoridation practices, said he and other activists have been unsuccessful in bringing the issue to the attention of Raleigh officials.

“Raleigh, unfortunately, has been provided with copious amounts of scientific data, repeated appearances by myself and other citizens and even notifications that what they are doing breaks current state and federal drug laws,” Sturmer said.

Efforts to reach Raleigh’s assistant director of public utilities were unsuccessful, but a page on the City of Raleigh website indicates its continued support of current fluoridation practices.

Continue Reading @ News & Observer…

ORIGINAL ARTICLE: Association of vascular fluoride uptake with vascular calcification and Coronary Artery Disease

A January 2012 study published by the VA Greater Los Angeles Healthcare System has linked Sodium Fluoride uptake with the hardening & calcification of major arteries, also known as Cardiovascular disease & the number one cause of death in the United States.

The study first appeared in the Nuclear Medicine Communications Journal, a “rapid communications journal publishing research and clinical work in all areas of nuclear medicine for an international readership,”  but these observations have not yet been picked up by the collective.  The research was performed by nuclear medicine physicians who retrospectively reviewed the imaging data and cardiovascular history of 61 patients who received whole-body sodium [F]fluoride PET/CT studies at their institution from 2009 to 2010. Fluoride uptake and calcification in major arteries, including coronary arteries, were analyzed by both visual assessment and standardized uptake value measurement.

In the introduction section it is interestingly noted that the phenomenon of hardening arteries & what risks that may pose to our health has been extensively studied, however Fluoride uptake & it’s clinical significance to coronary arteries has not yet been documented:

To predict and prevent any deadly cardiovascular events, extensive studies have been conducted to evaluate the risk of cardiovascular disease.  Over the past decade, many cardiovascular studies focused on the calcification process in atherosclerosis (hardening of arteries).  Calcification in atherosclerosis occurs through an active process that resembles bone formation and is controlled by complex enzymatic and cellular pathways.  Coronary artery calcification parallels atherosclerosis progress and is strongly and linearly correlated with fluorodeoxyglucose uptake in coronary arteries.  However, the clinical significance of fluoride uptake in coronoary arteries has not been documented.

The results of this study therefore have vast implications for our collectively becoming aware of one main contributing factor to the ongoing scourge heart disease, namely municipal water fluoridation.  This is especially true in consideration that 80% of Americans are since 1957 forcibly fluoridated  via their public drinking water & cardiovascular disease still remains the #1 cause of death in America (600,000/year).

Despite this study’s relative significance to the research produced by Harvard which concluded higher Fluoride uptake predictably lowers the Intelligence Quotient in humans, these specific conclusions have unfortunately not made it into mainstream news to the same degree. Although the full article admits more research should be conducted on the clinical significance of Fluoride uptake, this is the exact problem we face (lack of studies) nearly 60 years into the forced, highly systematic & ubiquitous fluoridation of our municipal water supplies!  One wonders the true extent of damage done if our scientists are only just now realizing the tragic link between Fluoride uptake & a disease that kills more Americans than one hundred and seventy  9/11s combined EACH YEAR

This blows a huge hole in the already horrendously flawed pro-fluoride argument which posits that drinking Fluoride only affects the teeth and does not have any health hazards to other organs of the body.  For fluoride fighters in the area, listen to me debunk local Public Health Terrorist Rebecca King once more, who ridiculously claims ingestion of fluoride is the best thing since sliced bread as it returns to the mouth in our saliva & continuously bathes our teeth in Fluoride-rich fluid! Such a bold faced & twisted manipulation of the facts is incredible in that it intrinsically admits Fluoride is penetrating all cells of the body- even the salivation glands.

So What were the results?

Patients

There were 58 male patients and three female patients. Detailed clinical histories and the presence of cardiovascular risk factors, such as hypertension, diabetes, hypercholesterolemia, smoking history, obesity, and history of cardiovascular events, were obtained for all patients. The clinical characteristics of the patients are summarized in Table 1.

Table 1 Patients' Clinical CharacteristicsImaging and Statistical Analyses

sd_CTorthopedics_main_enCT and PET images were coregistered by the Philips Extended Brilliance workstation (Philips Healthcare). CT, PET, and fused PET/CT images were evaluated visually and semi-quantitatively simultaneously using the same workstation. All images were analyzed by two independent nuclear medicine physicians blinded to all patients’ clinical information. Inter-reader reproducibility was excellent and was evaluated using an intraclass correlation coefficient (0.89). Vascular calcification was identified as positive on CT images if the target was visually detectable with a greater than 130 Hounsfield units. CT-attenuated PET images were evaluated for fluoride uptake in major arteries. Background activity was based on the standardized uptake value (SUV) of the blood pool, which was calculated from the mean SUVs of three circular regions of interest (ROIs) placed in the left atrium, mid lumen of the aortic arch, and abdominal aorta at the level of the celiac trunk on axial images. The sizes of ROIs were 2cm in diameter for the left atrium and 1cm for the aortic arch and the abdominal aorta.

Results (Abbreviated, click link to view original article)

Patients’ age and reasons for sodium fluoride PET/CT imaging are summarized in Table 1.  Most patients were men with a median age of 66 years (27-91 years).  The majority of patients (69%) had more than one risk factor for coronary artery disease.

Arterial sodium Fluoride uptake and calcification

Arterial wall sodium fluoride uptake and calcification were evaluated in major arteries, including carotid arteries, the thoracic ascending (including aortic arch) aorta, the thoracic descending aorta, the abdominal aorta, femoral arteries, and major branches of coronary arteries. Iliac arteries were not evaluated because of frequently observed urinary and occasional bowel uptake in the pelvis, which interferes with the accurate assessment of iliac vessels. For coronary arteries, four major branches were evaluated. An example of fluoride uptake in femoral arteries is shown in Fig. 1. Orthogonal views of fluoride uptake in the aorta and coronary arteries are shown in Figs 2 and 3.
Figure1
Figure 2Figure3Relationship between coronary fluoride uptake and cardiovascular risk factors
The coronary arteries were also investigated for fluoride uptake. Four major branches of coronary arteries, including left main artery (LMA), left anterior descending (LAD), left circumflex (LCA), and right coronary arteriy (RCA) were evaluated. Fluoride uptake was more frequently observed in the LAD and LCAs.  A similar pattern was also identified in coronary artery calcification. In each individual coronary branch, calcification was more frequently observed than fluoride uptake (Table 2).  Table2
  • Among 10 patients who had significant three-vessel coronary calcifications, 80% demonstrated fluoride uptake in at least one coronary branch (data not shown).
  • Cardiovascular risk factors including hypertension, obesity, diabetes, hypercholesterolemia, smoking history, and history of coronary artery disease were reviewed in all patients (Table 3).
  • The majority of the patients (69%) had more than one cardiovascular risk factor; however, neither the individual cardiovascular risk factor nor the number of risk factors was significantly correlated with coronary fluoride uptake (Table 3).
Table3
Nine patients had a history of cardiovascular events. Among them, eight demonstrated identifiable coronary fluoride uptake. There was significant correlation between coronary calcification and fluoride uptake in this group evaluated by Fisher’s exact test (Table 3). All nine patients also demonstrated coronary calcification on CT images. We also compared the SUVmax in coronary arteries between patients with and without a history of cardiovascular events. The average coronary SUV max in patients with a history of cardiovascular events was 1.70, significantly higher than 1.39 for patients without a history of cardiovascular events (P=0.029, two-tailed Student’s t-test). No correlation was observed between cardiovascular risk factors and fluoride uptake in other vascular territories (noncoronary).

Discussion Highlights

Vascular calcification, in particular coronary calcification, has been shown to predict vascular events [25–27]. 

In our study, fluoride uptake and CT calcification are significantly correlated in the same arterial territories, except in the abdominal aorta. This is because of the extremely high positive rate (97%, only one patient demonstrated negative uptake) for fluoride uptake in the abdominal aorta.

 Fluoride uptake either overlaps with calcification or locates adjacent to the detectable calcium deposits, suggesting that fluoride uptake and detectable calcification represent different stages of the atherosclerotic process.

 We found that fluoride uptake in coronary arteries is significantly correlated with a patient’s history of cardiovascular events, and the uptake value in patients with cardiovascular events was significantly higher than that in patients without cardiovascular events. These results further support the fact that higher fluoride uptake in coronary arteries indicates increased cardiovascular risk.

The combination of sodium [18F]fluoride PET and CT is a promising imaging modality that provides both metabolic and anatomic information in evaluating vascular calcification. However, large-scale studies are needed to evaluate the clinical significance of fluoride PET/CT for imaging atherosclerosis.

Conclusion

Our study demonstrates that vascular calcification and fluoride uptake are significantly correlated in the same arterial territory, although not necessarily overlapping in the same anatomic locations. An increased fluoride uptake in coronary arteries may be associated with an increased cardiovascular risk. Combined anatomic and metabolic imaging with sodium [18F]fluoride PET/CT offers a promising, noninvasive method to evaluate atherosclerosis.