Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
ISGlobal, Barcelona, Spain.
JAMA Netw Open. 2023 Sep 5;6(9):e2333347. doi: 10.1001/jamanetworkopen.2023.33347.
Cardiovascular toxic effects derived from high exposures to individual organochlorine compounds are well documented. However, there is no evidence on low but continuous exposure to combined organochlorine compounds in the general population.
To evaluate the association of combined exposure to several organochlorine compounds, including organochlorine pesticides and polychlorinated biphenyls, with incident cardiovascular disease (CVD) in the general population.
DESIGN, SETTING, AND PARTICIPANTS: This prospective nested case-control study included data from 2 cohorts: the Swedish Mammography Cohort-Clinical (SMC-C) and the Cohort of 60-Year-Olds (60YO), with matched case-control pairs based on age, sex, and sample date. Baseline blood sampling occurred from November 2003 to September 2009 (SMC-C) and from August 1997 to March 1999 (60YO), with follow-up through December 2017 (SMC-C) and December 2014 (60YO). Participants with myocardial infarction or ischemic stroke were matched with controls for composite CVD evaluation. Data were analyzed from September 2020 to May 2023.
A total of 25 organochlorine compounds were measured in blood at baseline by gas chromatography-triple quadrupole mass spectrometry. For 7 compounds, more than 75% of the samples were lower than the limit of detection and not included.
Incident cases of primary myocardial infarction and ischemic stroke were ascertained via linkage to the National Patient Register (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes I21 and I63). The quantile-based g-computation method was used to estimate the association between the combined exposure to several organochlorine compounds and composite CVD.
Of 1528 included participants, 1024 (67.0%) were female, and the mean (SD) age was 72 (7.0) years in the SMC-C and 61 (0.1) years in the 60YO. The odds ratio of composite CVD was 1.71 (95% CI, 1.11-2.64) per 1-quartile increment of total organochlorine compounds mixture. Organochlorinated pesticides were the largest contributors, and β-hexachlorocyclohexane and transnonachlor had the highest impact. Most of the outcome was not explained by disturbances in the main cardiometabolic risk factors, ie, high body mass index, hypertension, lipid alteration, or diabetes.
In this prospective nested case-control study, participants with higher exposures to organochlorines had an increased probability of experiencing a cardiovascular event, the major cause of death worldwide. Measures may be required to reduce these exposures.
高暴露于个体有机氯化合物导致的心血管毒性效应已有充分的文献记载。然而，对于一般人群中低但持续暴露于混合有机氯化合物的情况，尚无证据。
评估几种有机氯化合物（包括有机氯农药和多氯联苯）的联合暴露与普通人群中心血管疾病（CVD）发病的关联。
设计、设置和参与者：这项前瞻性嵌套病例对照研究包括来自两个队列的数据：瑞典乳腺摄影队列-临床队列（SMC-C）和 60 岁队列（60YO），根据年龄、性别和样本日期进行病例对照配对。基线血液采样于 2003 年 11 月至 2009 年 9 月（SMC-C）和 1997 年 8 月至 1999 年 3 月（60YO）进行，随访至 2017 年 12 月（SMC-C）和 2014 年 12 月（60YO）。心肌梗死或缺血性中风的患者与复合 CVD 评估的对照组相匹配。数据于 2020 年 9 月至 2023 年 5 月进行分析。
基线时通过气相色谱-三重四极杆质谱法对血液中的 25 种有机氯化合物进行了测量。有 7 种化合物的样本中，超过 75%的样本低于检测限，未被包括在内。
原发性心肌梗死和缺血性中风的首发病例通过与国家患者登记处（国际疾病分类和相关健康问题第十次修订代码 I21 和 I63）相关联来确定。基于分位数的 g 计算法用于估计几种有机氯化合物联合暴露与复合 CVD 之间的关联。
在纳入的 1528 名参与者中，1024 名（67.0%）为女性，SMC-C 组的平均（SD）年龄为 72（7.0）岁，60YO 组的平均（SD）年龄为 61（0.1）岁。每增加一个有机氯化合物混合物四分位间距，复合 CVD 的比值比为 1.71（95%CI，1.11-2.64）。有机氯农药是最大的贡献者，β-六氯环己烷和反式非诺氯烷的影响最大。大部分结果不能用主要心血管代谢风险因素（即高体重指数、高血压、脂质改变或糖尿病）的干扰来解释。
在这项前瞻性嵌套病例对照研究中，有机氯暴露水平较高的参与者发生心血管事件的可能性增加，而心血管事件是全球主要的死亡原因。可能需要采取措施来减少这些暴露。
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