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Association of increased risk of cardiovascular diseases with higher levels of perfluoroalkylated substances in the serum of adults

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Abstract

Evidence showing the association of perfluoroalkylated substance (PFAS) exposure with CVD risk is scarce. The objective of this study was to explore the relationships of CVD risk with mixed or individual serum PFAS levels among general adults. We analyzed combined data of 7904 adults who participated in the National Health and Nutrition Examination Survey 2003–2012 with a Bayesian kernel machine regression (BKMR) to examine the relationships of individual or mixed PFAS exposure with total CVD risk. A logistic regression model and restricted cubic spline (RCS) regression with multivariate adjustment were conducted to assess the relationships between individual serum PFAS levels and the risk of total CVD or its subtypes. A mediation model was applied to investigate how C-reactive protein (CRP) levels mediate the strength of the association. The BKMR results indicated a positive relationship between mixed PFAS exposure and total CVD risk; among the PFASs, perfluorooctane sulfonic acid (PFOS) had the highest posterior inclusion probability. As determined by logistic regression, a log-unit change in PFOS levels was positively related to a higher risk of heart attack and stroke in males (both P < 0.05). A nonlinear relationship was found between PFOS levels and stroke risk (P for nonlinearity = 0.04), as illustrated in the RCS plot. The mediation analysis showed that CRP levels mediated 8% and 1.2% of the relationship between serum PFOS and PFNA levels, respectively, and the prevalence of stroke. A significant relationship between higher serum PFAS concentrations and an increased risk of CVD was observed, mainly in males.

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Availability of data and materials

The datasets used and analyzed during the current study are available at https://www.cdc.gov/nchs/nhanes/nhanes_questionnaires.htm.

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Funding

Our study was funded by the Medical Science and Technology Development Foundation, Jiangsu Provincial Commission of Health and Family Planning (grant no. ZDRCA2016073).

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, China

    Xinghui Feng, Guowei Zeng, Qi Zhang, Binqian Song & Kai-Hong Wu

  2. Department of Clinical Laboratory, Children’s Hospital of Nanjing Medical University, Nanjing, 210008, China

    Guangfeng Long

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  1. Xinghui Feng
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  2. Guangfeng Long
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  3. Guowei Zeng
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  4. Qi Zhang
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Contributions

K.H.W. and G.W.Z.: conceptualization. K.H.W. and Q.Z.: writing—original draft preparation. X.H.F. and G.F.L.: data curation and investigation. X.H.F. and Q.Z.: methodology and writing—review and editing. B.Q.S. and G.W.Z.: project administration. B.Q.S.: validation and supervision. K.H.W., G.F.L. and G.W.Z.: writing—review and editing.

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Correspondence to Kai-Hong Wu.

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The consent form was signed by the survey participants, and the participants consented to storing specimens of their blood for future research. The CDC/NCHS Ethics Review Board approved the NHANES study and gave approval for public dissemination.

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Not applicable. There are no individual-level data in our publication.

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The authors declare no competing interests.

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Xinghui Feng and Guangfeng Long contributed equally to the present study and are joint first authors.

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Feng, X., Long, G., Zeng, G. et al. Association of increased risk of cardiovascular diseases with higher levels of perfluoroalkylated substances in the serum of adults. Environ Sci Pollut Res 29, 89081–89092 (2022). https://doi.org/10.1007/s11356-022-22021-z

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