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Exposure to phthalates and cardiovascular diseases in Chinese with type 2 diabetes

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Abstract

Cardiovascular disease (CVD) results in more than half of the mortality and the majority of morbidity in patients with type 2 diabetes. We aim to evaluate the associations of urinary concentrations of phthalate metabolites with CVD in diabetic patients and explore whether CVD risk factors mediate or interact with these associations. A total of 675 type 2 diabetic participants were enrolled from Shanghai, China, in 2018. CVD was defined as a self-reported diagnosis by a physician including coronary heart disease, myocardial infarction, or stroke; it was further reconfirmed in the records from the registration platform. Ten phthalate metabolites were measured in urine. We found positive associations were found among the level of monoethyl phthalate and monoisobutyl phthalate and CVD (OR 1.138, 95% CI 1.032, 1.254; OR 1.369, 95% CI 1.049, 1.786, respectively). Monoisobutyl phthalate and monobenzyl phthalate were marginally and positively associated with carotid intima-media thickness and common carotid artery diameter, respectively. None of the CVD risk factors, including HOMA-IR, body mass index, lipid profile, or blood pressure, significantly mediated the association between the metabolites and CVD. The conditional indirect effect on CVD was significantly stronger for current smoking and dyslipidemia for monoethyl phthalate and for no statin usage and men for monoisobutyl phthalate. In conclusion, phthalate exposure was positively associated with CVD in Chinese with type 2 diabetes. Type 2 diabetic men who are currently smoking, have an uncontrolled lipid profile, and are not using statins might be more susceptible to CVD when exposed to phthalates.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

Funding

This study was supported by the National Natural Science Foundation of China (91857117); the Science and Technology Commission of Shanghai Municipality (19140902400, 18410722300); the Major Science and Technology Innovation Program of Shanghai Municipal Education Commission (2019-01-07-00-01-E00059); the Commission of Health and Family Planning of Pudong District (PWZxq2017-17); and the Shanghai JiaoTong University School of Medicine (19XJ11007).

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  1. Haojie Zhang and Jingsi Chen contributed equally to this work.

Authors and Affiliations

  1. Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011, China

    Haojie Zhang, Chi Chen, Heng Wan, Yi Chen, Yuying Wang, Wen Zhang, Ningjian Wang & Yingli Lu

  2. Key Laboratory of Public Health Safety of Ministry of Education, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health, Fudan University, Shanghai, China

    Jingsi Chen & Bo Chen

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  1. Haojie Zhang
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Contributions

N.W., Y.L., and B.C. designed the study; H.Z., J.C., C.C., H.W., Y.C., W.Z., Y.Z., and N.W. conducted the research; H.Z. and J.C. analyzed the data and wrote the manuscript. The final manuscript was read and approved by all authors.

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Correspondence to Bo Chen, Ningjian Wang or Yingli Lu.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Zhang, H., Chen, J., Chen, C. et al. Exposure to phthalates and cardiovascular diseases in Chinese with type 2 diabetes. Environ Sci Pollut Res 28, 58113–58122 (2021). https://doi.org/10.1007/s11356-021-14807-4

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