Epidemiology and Public Health Group, Peninsula College of Medicine and Dentistry, Barrack Road, Exeter, United Kingdom.
Circulation. 2012 Mar 27;125(12):1482-90. doi: 10.1161/CIRCULATIONAHA.111.069153. Epub 2012 Feb 21.
The endocrine-disrupting chemical bisphenol A (BPA) is widely used in food and beverage packaging. Higher urinary BPA concentrations were cross-sectionally associated with heart disease in National Health and Nutrition Examination Survey (NHANES) 2003-2004 and NHANES 2005-2006, independent of traditional risk factors.
We included 758 incident coronary artery disease (CAD) cases and 861 controls followed for 10.8 years from the European Prospective Investigation of Cancer-Norfolk UK. Respondents aged 40 to 74 years and free of CAD, stroke, or diabetes mellitus provided baseline spot urine samples. Urinary BPA concentrations (median value, 1.3 ng/mL) were low. Per-SD (4.56 ng/mL) increases in urinary BPA concentration were associated with incident CAD in age-, sex-, and urinary creatinine-adjusted models (n=1919; odds ratio=1.13; 95% confidence interval, 1.02-1.24; P=0.017). With CAD risk factor adjustment (including education, occupational social class, body mass index category, systolic blood pressure, lipid concentrations, and exercise), the estimate was similar but narrowly missed 2-sided significance (n=1744; odds ratio=1.11; 95% confidence interval, 1.00-1.23; P=0.058). Sensitivity analyses with the fully adjusted model, excluding those with early CAD (<3-year follow-up), body mass index >30, or abnormal renal function or with additional adjustment for vitamin C, C-reactive protein, or alcohol consumption, all produced similar estimates, and all showed associations at P≤0.05.
Associations between higher BPA exposure (reflected in higher urinary concentrations) and incident CAD during >10 years of follow-up showed trends similar to previously reported cross-sectional findings in the more highly exposed NHANES respondents. Further work is needed to accurately estimate the prospective exposure-response curve and to establish the underlying mechanisms.
内分泌干扰化学物质双酚 A（BPA）广泛应用于食品和饮料包装。在 2003-2004 年和 2005-2006 年的国家健康和营养调查（NHANES）中，与传统危险因素无关，较高的尿 BPA 浓度与心脏病呈横断面相关。
我们纳入了 758 例冠心病（CAD）发病病例和 861 例对照，从欧洲前瞻性癌症调查-英国诺福克开始随访 10.8 年。年龄在 40-74 岁之间，无 CAD、中风或糖尿病的受访者提供基线点尿样。尿 BPA 浓度（中位数为 1.3ng/ml）较低。在年龄、性别和尿肌酐调整模型中，每 SD（4.56ng/ml）尿 BPA 浓度增加与 CAD 发病相关（n=1919；比值比=1.13；95%置信区间，1.02-1.24；P=0.017）。与 CAD 危险因素调整（包括教育、职业社会阶层、体重指数类别、收缩压、血脂浓度和运动）后，估计值相似，但略低于双侧显著性（n=1744；比值比=1.11；95%置信区间，1.00-1.23；P=0.058）。用完全调整模型进行的敏感性分析，排除了那些 CAD 发病时间较早（<3 年随访）、体重指数>30 或肾功能异常的患者，或用维生素 C、C 反应蛋白或酒精摄入量进行额外调整的患者，所有这些都产生了类似的估计值，且所有结果都表明在 P≤0.05 时有相关性。
在超过 10 年的随访期间，较高的 BPA 暴露（反映在较高的尿液浓度）与 CAD 发病之间的关联趋势与之前在 NHANES 高暴露人群中报道的横断面发现相似。需要进一步工作来准确估计前瞻性暴露-反应曲线，并确定潜在机制。
