Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Republic of Korea.
Sci Total Environ. 2021 Apr 1;763:142941. doi: 10.1016/j.scitotenv.2020.142941. Epub 2020 Oct 14.
As the most widely consumed endocrine-disrupting chemical, bisphenol A (BPA) has been linked to reproductive dysfunction, diabetes mellitus, and obesity. However, the evidence for an association between BPA and cardiovascular disease (CVD) remains insufficient. In the present study, we aimed to identify the association between BPA and CVD, using data from the 2003-2016 National Health and Nutrition Examination Surveys (NHANES). We estimated urine BPA concentration after adjustments for creatinine (ng/mg) and normalized the asymmetrical distribution using natural logarithmic transformation (ln-BPA/Cr). A multivariate logistic regression was performed to evaluate the odds ratio (OR) and 95% confidence interval (CI) for CVD, with ln-BPA/Cr concentration as predictor. We then performed a Mantel-Haenszel meta-analysis with five eligible studies and NHANES 2003-2016 data. Our subjects were 11,857 adults from the NHANES data. After adjusting for age, sex, race/ethnicity, body mass index (BMI), cigarette smoking, diabetes status, hypertension, and dyslipidemia, OR between ln-BPA/Cr and CVD was 1.13 (95% CI: 1.02-1.24). After propensity-score-matching with age, sex, race/ethnicity, BMI, cigarette smoking, diabetes, hypertension, and dyslipidemia, OR continued to be significant for the association between ln-BPA/Cr and CVD (OR: 1.18, 95% CI: 1.04-1.33). A restricted cubic spline plot of this relationship revealed a dose-dependent increase in OR. However, untransformed BPA had a linear relationship with CVD only at low concentrations, whereas the OR of BPA plateaued at high concentrations. In a meta-analysis with 22,878 subjects, after adjusting for age, sex, and various cardiometabolic risk factors, OR was 1.13 (95% CI, 1.03-1.23). In conclusion, our study provides additional epidemiological evidence supporting an association between BPA and CVD.
作为最广泛消费的内分泌干扰化学物质，双酚 A（BPA）与生殖功能障碍、糖尿病和肥胖有关。然而，BPA 与心血管疾病（CVD）之间的关联证据仍然不足。在本研究中，我们旨在使用 2003-2016 年全国健康和营养调查（NHANES）的数据，确定 BPA 与 CVD 之间的关联。我们在肌酐（ng/mg）调整后估计尿液 BPA 浓度，并使用自然对数转换（ln-BPA/Cr）对非对称分布进行归一化。使用多元逻辑回归评估 CVD 的优势比（OR）和 95%置信区间（CI），ln-BPA/Cr 浓度为预测因子。然后，我们使用五项符合条件的研究和 NHANES 2003-2016 数据进行 Mantel-Haenszel 荟萃分析。我们的研究对象是 NHANES 数据中的 11857 名成年人。在调整年龄、性别、种族/民族、体重指数（BMI）、吸烟、糖尿病状况、高血压和血脂异常后，ln-BPA/Cr 与 CVD 之间的 OR 为 1.13（95%CI：1.02-1.24）。在与年龄、性别、种族/民族、BMI、吸烟、糖尿病、高血压和血脂异常进行倾向评分匹配后，ln-BPA/Cr 与 CVD 之间的关联仍然具有统计学意义（OR：1.18，95%CI：1.04-1.33）。这种关系的限制立方样条图显示出 OR 的剂量依赖性增加。然而，未经转换的 BPA 仅在低浓度时与 CVD 呈线性关系，而 BPA 的 OR 在高浓度时趋于平稳。在一项纳入 22878 名受试者的荟萃分析中，在调整年龄、性别和各种心血管代谢危险因素后，OR 为 1.13（95%CI，1.03-1.23）。总之，我们的研究提供了额外的流行病学证据，支持 BPA 与 CVD 之间的关联。
