Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea.
Rev Environ Health. 2023 Sep 4;39(4):791-800. doi: 10.1515/reveh-2023-0021. Print 2024 Dec 17.
Evidence of the adverse metabolic health effects of perfluoroalkyl and polyfluoroalkyl substances (PFAS) is increasing. However, the impact of PFAS on cardiovascular diseases remains controversial. This meta-analysis aimed to analyze the impact of PFAS on the stroke risk.
Databases were searched for studies published up to November 1, 2022, which report the association between stroke and exposure to at least one of four main PFAS (perfluorooctanoic acid [PFOA], perfluorooctanesulfonic acid [PFOS], perfluorononanoic acid [PFNA], and perfluorohexane sulfonic acid [PFHxS]). Data extraction and quality assessment were performed according to the Newcastle-Ottawa scale.
Four studies were included in this systematic review. Multivariate adjusted odds ratios (ORs) for incident stroke per 1-log unit increment in each serum PFAS were combined in the meta-analysis. The risk of development of stroke was not significantly associated with PFOA, PFOS, or PFNA exposure (PFOA: pooled odds ratio [OR]=1.001, 95 % confidence interval [CI]=0.975-1.028, p=0.934; PFOS: pooled OR=0.994, 95 % CI=0.972-1.017, p=0.601; PFNA: pooled OR=1.016, 95 % CI=0.920-1.123, p=0.752), whereas a moderately lower risk was associated with PFHxS exposure without statistical significance (pooled OR=0.953, 95 % CI=0.908-1.001, p=0.054). PFOA, PFOS, and PFNA exposure showed a neutral association, while PFHxS showed a possible inverse association with the risk of stroke. Therefore, this finding should be interpreted with caution. Further prospective observational studies with PFAS mixture analyses are warranted.
越来越多的证据表明全氟烷基和多氟烷基物质（PFAS）对代谢健康有不良影响。然而，PFAS 对心血管疾病的影响仍存在争议。本荟萃分析旨在分析 PFAS 对中风风险的影响。
检索了截至 2022 年 11 月 1 日发表的研究，这些研究报告了至少一种四种主要 PFAS（全氟辛酸[PFOA]、全氟辛烷磺酸[PFOS]、全氟壬酸[PFNA]和全氟己烷磺酸[PFHxS]）暴露与中风之间的关联。根据纽卡斯尔-渥太华量表进行数据提取和质量评估。
本系统评价纳入了四项研究。对每种血清 PFAS 每增加 1 个对数单位的中风发生率进行多变量调整后，将比值比（OR）合并进行荟萃分析。PFAS 暴露与中风发生风险无显著相关性（PFOA：汇总 OR=1.001，95%置信区间[CI]=0.975-1.028，p=0.934；PFOS：汇总 OR=0.994，95% CI=0.972-1.017，p=0.601；PFNA：汇总 OR=1.016，95% CI=0.920-1.123，p=0.752），而 PFHxS 暴露与中风风险呈中度降低趋势，但无统计学意义（汇总 OR=0.953，95% CI=0.908-1.001，p=0.054）。PFOA、PFOS 和 PFNA 暴露呈中性关联，而 PFHxS 与中风风险呈可能的反向关联。因此，这一发现应谨慎解释。需要进一步进行前瞻性观察性研究，分析 PFAS 混合物。
