Winquist Andrea, Steenland Kyle
Environmental Health Department, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
Environ Health Perspect. 2014 Dec;122(12):1299-305. doi: 10.1289/ehp.1307943. Epub 2014 Sep 26.
Several previous studies, mostly cross-sectional, have found associations between perfluorooctanoic acid (PFOA) and high cholesterol levels, but studies of hypertension and heart disease have had inconsistent findings.
In this study we examined the association between modeled PFOA exposure and incident hypertension, hypercholesterolemia, and coronary artery disease among workers at a Mid-Ohio Valley chemical plant that used PFOA, and residents of the surrounding community.
Community- and worker-cohort participants completed surveys during 2008-2011 covering demographics, health-related behaviors, and medical history. Cox proportional hazard models, stratified by birth year, modeled the hazard of each outcome (starting at 20 years of age) as a function of retrospective serum PFOA concentration estimates (generated through fate, transport and exposure modeling), controlling for sex, race, education, smoking, alcohol use, body mass index, and diabetes.
Among 32,254 participants (28,541 community; 3,713 worker), 12,325 reported hypertension with medication, 9,909 reported hypercholesterolemia with medication, and 3,147 reported coronary artery disease (2,550 validated). Hypercholesterolemia incidence increased with increasing cumulative PFOA exposure (sum of yearly serum concentration estimates), most notably among males 40-60 years of age. Compared with the lowest exposure quintile (< 142 ng/mL-years), hazard ratios for subsequent quintiles (ng/mL-years: 142 to < 234; 234 to < 630; 630 to < 3,579; ≥ 3,579) were 1.24, 1.17, 1.19, and 1.19 overall and 1.38, 1.32, 1.31, and 1.44 among men 40-60 years of age. There was no apparent association between PFOA exposure and hypertension or coronary artery disease incidence.
Higher PFOA exposure was associated with incident hypercholesterolemia with medication, but not with hypertension or coronary artery disease.
此前的几项研究（大多为横断面研究）发现全氟辛酸（PFOA）与高胆固醇水平之间存在关联，但关于高血压和心脏病的研究结果并不一致。
在本研究中，我们调查了俄亥俄州中部山谷一家使用PFOA的化工厂工人以及周边社区居民中，模拟的PFOA暴露与新发高血压、高胆固醇血症和冠状动脉疾病之间的关联。
社区和工人队列参与者在2008 - 2011年期间完成了涵盖人口统计学、健康相关行为和病史的调查。按出生年份分层的Cox比例风险模型，将每个结局（从20岁开始）的风险建模为回顾性血清PFOA浓度估计值（通过归宿、迁移和暴露模型生成）的函数，同时控制性别、种族、教育程度、吸烟、饮酒、体重指数和糖尿病。
在32254名参与者中（28541名社区居民；3713名工人），12325人报告患有需药物治疗的高血压，9909人报告患有需药物治疗的高胆固醇血症，3147人报告患有冠状动脉疾病（2550例经证实）。高胆固醇血症发病率随累积PFOA暴露量（年度血清浓度估计值之和）的增加而增加，在40 - 60岁男性中最为明显。与最低暴露五分位数（< 142 ng/mL - 年）相比，后续五分位数（ng/mL - 年：142至< 234；234至< 630；630至< 3579；≥ 3579）的总体风险比分别为1.24、1.17、1.19和1.19，在40 - 60岁男性中分别为1.38、1.32、1.31和1.44。PFOA暴露与高血压或冠状动脉疾病发病率之间无明显关联。
较高的PFOA暴露与需药物治疗的新发高胆固醇血症有关，但与高血压或冠状动脉疾病无关。
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