Shankar Anoop, Xiao Jie, Ducatman Alan
Department of Epidemiology, West Virginia University School of Public Health, Morgantown, 26506, USA.
Arch Intern Med. 2012 Oct 8;172(18):1397-403. doi: 10.1001/archinternmed.2012.3393.
Cardiovascular disease (CVD) is a major public health problem. Identifying novel risk factors for CVD, including widely prevalent environmental exposures, is therefore important. Perfluorooctanoic acid (PFOA) is a manmade chemical used in the manufacture of common household consumer products. Biomonitoring surveys have shown that PFOA is detectable in the blood of more than 98% of the US population. Experimental animal studies suggest that an association between PFOA and CVD is plausible. However, this association in humans has not been previously examined. We therefore examined the independent relationship between serum PFOA levels and CVD outcomes in a representative sample of Americans.
We examined 1216 subjects (51.2% women) from the 1999-2003 National Health and Nutritional Examination Survey. Serum PFOA levels were examined in quartiles. The main outcomes of interest were self-reported CVD, including coronary heart disease and stroke, and objectively measured peripheral arterial disease (PAD), defined as an ankle-brachial blood pressure index of less than 0.9.
We found that increasing serum PFOA levels are positively associated with CVD and PAD, independent of confounders such as age, sex, race/ethnicity, smoking status, body mass index, diabetes mellitus, hypertension, and serum cholesterol level. Compared with quartile 1 (reference) of PFOA level, the multivariable odds ratio (95% CI) among subjects in quartile 4 was 2.01 (1.12-3.60; P = .01 for trend) for CVD and 1.78 (1.03-3.08; P = .04 for trend) for PAD.
Exposure to PFOA is associated with CVD and PAD, independent of traditional cardiovascular risk factors.
心血管疾病（CVD）是一个主要的公共卫生问题。因此，识别CVD的新危险因素，包括广泛存在的环境暴露因素，具有重要意义。全氟辛酸（PFOA）是一种用于制造普通家用消费品的人造化学品。生物监测调查显示，超过98%的美国人群血液中可检测到PFOA。实验动物研究表明，PFOA与CVD之间存在关联是合理的。然而，此前尚未对人类中的这种关联进行过研究。因此，我们在一个具有代表性的美国人群样本中，研究了血清PFOA水平与CVD结局之间的独立关系。
我们研究了1999 - 2003年国家健康与营养检查调查中的1216名受试者（51.2%为女性）。血清PFOA水平按四分位数进行分析。主要关注的结局是自我报告的CVD，包括冠心病和中风，以及客观测量的外周动脉疾病（PAD），定义为踝臂血压指数小于0.9。
我们发现，血清PFOA水平升高与CVD和PAD呈正相关，且不受年龄、性别、种族/民族、吸烟状况、体重指数、糖尿病、高血压和血清胆固醇水平等混杂因素的影响。与PFOA水平的第一四分位数（参考值）相比，第四四分位数受试者中CVD的多变量优势比（95%CI）为2.01（1.12 - 3.60；趋势P = 0.01），PAD为1.78（1.03 - 3.08；趋势P = 0.04）。
接触PFOA与CVD和PAD相关，独立于传统的心血管危险因素。
