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Associations of ethylene oxide exposure and “Life’s Essential 8”

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Abstract

Ethylene oxide (EtO) is a widely used industrial chemical with recognized health risks. While its carcinogenic properties have been extensively studied, emerging evidence suggests potential associations with cardiovascular diseases. Using the recently introduced Life’s Essential 8 (LE8) score as a comprehensive cardiovascular health (CVH) measure, this study aimed to elucidate the relationship between EtO exposure and CVH. Data from the National Health and Nutrition Examination Survey (NHANES) encompassing 3748 adults was analyzed. CVH was assessed using the LE8 score, which incorporates diet, physical activity, tobacco/nicotine exposure, sleep duration, BMI, non-HDL cholesterol, blood glucose, and blood pressure. The association between EtO exposure, gauged by Hemoglobin adduct (HbEtO) levels, and CVH was examined using linear regression and Cox regression models. An inverse relationship between EtO exposure and the overall CVH score was identified. Specifically, for every 1-unit increase in ln-transformed HbEtO, a 3.69-point decrease in the total CVH score was observed. An inverted J-shaped association between ln-transformed HbEtO and CVH score emerged, with an inflection point at 3.15 pmol/g Hb. Elevated EtO exposure was not significantly linked to all-cause mortality but was robustly associated with increased cardiovascular mortality. Elevated EtO exposure is negatively associated with CVH, as outlined by the LE8 metrics. Beyond a certain threshold, this association underscores the cardiovascular risks of EtO exposure and highlights the importance of further research to determine underlying mechanisms and recommend preventive strategies.

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Data Availability

The survey data are publicly available on the internet for data users and researchers throughout the world (www.cdc.gov/nchs/nhanes/).

Abbreviations

EtO:

Ethylene oxide

HbEtO:

Hemoglobin adducts of ethylene oxide

LE8:

Life’s Essential 8

CVH:

Cardiovascular health

COPD:

Chronic obstructive pulmonary disease

AHA:

American Heart Association

LS7:

Life’s Simple 7

NHANES:

National Health and Nutrition Examination Survey

non-HDL:

Non-high-density lipoprotein cholesterol

CVD:

Cardiovascular disease

NCHS:

National Center for Health Statistics

BMI:

Body mass index

DASH:

Dietary approaches to stop hypertension

HPLC-MS/MS:

High-performance liquid chromatography coupled with tandem mass spectrometry

ICD-10:

International Classification of Diseases

SD:

Standard deviation

RCS:

Restricted cubic spline

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Acknowledgements

Graphical abstract partially created by BioRender (https://biorender.com/).

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Authors and Affiliations

  1. Department of Hand & Microsurgery, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, 421002, China

    Ruijie Xie, Changxiong Liu, Songlin Xie & Xiongjie Huang

  2. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Ruijie Xie

  3. Faculty of Medicine, University of Heidelberg, Heidelberg, Germany

    Ruijie Xie

  4. Hengyang Medical School, University of South China, Hengyang, China

    Linjian Liu

  5. Department of Gland Surgery, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, 421002, China

    Ya Zhang

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  1. Ruijie Xie
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Contributions

Writing manuscript: Ruijie Xie, Linjian Liu, Changxiong Liu, and Ya Zhang; data extraction and statistical analysis: Ruijie Xie, Linjian Liu and Songlin Xie; reviewing and editing: Linjian Liu, Xiongjie Huang, and Ya Zhang. conceptualization, project administration, and supervision: Ruijie Xie and Ya Zhang. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Ya Zhang.

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Ethics approval and consent to participate

All human subjects involved in this study were treated by the ethical principles outlined in the Declaration of Helsinki, and the study was approved by the Research Ethics Review Board of the National Center for Health Statistics (NCHS). The patients/participants provided their written informed consent to participate in this study.

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Ruijie Xie and Linjian Liu are the co-first authors of the manuscript.

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Xie, R., Liu, L., Liu, C. et al. Associations of ethylene oxide exposure and “Life’s Essential 8”. Environ Sci Pollut Res 30, 121150–121160 (2023). https://doi.org/10.1007/s11356-023-30741-z

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