Mérida Diana María, Torrijo-Belanche Carolina, Moreno-Franco Belén, Laclaustra Martín, Rey-García Jimena, Gimeno-Ruiz Sofía, Bayán-Bravo Ana, Guallar-Castillón Pilar
Department of Preventive Medicine and Public Health. School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain.
Department of Pharmacoepidemiology and Biostatistics, Fundación Teófilo Hernando, 28290 Las Rozas de Madrid, Spain.
Am J Prev Cardiol. 2025 Aug 6;23:101072. doi: 10.1016/j.ajpc.2025.101072. eCollection 2025 Sep.
Phthalates are implicated in mechanisms underlying the development of cardiovascular disease, such as oxidative stress, lipid peroxidation, endothelial dysfunction, and activation of procoagulant pathways. This study aimed to evaluate the association between phthalate exposure and subclinical coronary atherosclerosis (SCA).
A total of 1119 Spanish male workers from a car assembly plant (mean age: 50.9 years) were included. Urinary metabolites of 11 phthalates and ΣDEHP were analyzed. SCA was defined as coronary artery calcium ≥ 100 Agatston units. Logistic regression models were used to estimate the association between phthalates (natural log-transformed) and SCA, adjusting for sociodemographic, lifestyle, and cardiovascular risk factors. Dose-response relationships were explored using restricted cubic splines.
The prevalence of SCA was 10.2 %. Participants with SCA had a median Mono-ethyl phthalate (MEP) concentration of 126.1 µg/g-creatinine compared to 99.3 µg/g-creatinine in those without SCA. A 1-unit increase in the natural logarithm of MEP was associated with a 21 % higher prevalence of SCA (OR: 1.21; 95 % CI: 1.02-1.44), showing a linear relationship. Positive but non-significant associations were observed for MiBP and MnBP. Sensitivity analyses with phthalates in original units (ng/ml) and adjustments for urinary creatinine showed consistent results.
Exposure to MEP is associated with an increased prevalence of SCA in male workers, suggesting that the exposure to this phthalate may play a role in the early stages of cardiovascular disease. These findings provide a basis for public health initiatives aimed at reducing phthalate exposure for the primary prevention of cardiovascular disease.
邻苯二甲酸盐与心血管疾病发生机制有关，如氧化应激、脂质过氧化、内皮功能障碍和促凝血途径的激活。本研究旨在评估邻苯二甲酸盐暴露与亚临床冠状动脉粥样硬化（SCA）之间的关联。
纳入了一家汽车装配厂的1119名西班牙男性工人（平均年龄：50.9岁）。分析了11种邻苯二甲酸盐和ΣDEHP的尿代谢产物。SCA定义为冠状动脉钙化≥100阿加斯顿单位。使用逻辑回归模型估计邻苯二甲酸盐（自然对数转换）与SCA之间的关联，并对社会人口统计学、生活方式和心血管危险因素进行调整。使用受限立方样条探索剂量反应关系。
SCA的患病率为10.2%。患有SCA的参与者的邻苯二甲酸单乙酯（MEP）浓度中位数为126.1μg/g肌酐，而未患有SCA的参与者为99.3μg/g肌酐。MEP自然对数增加1个单位与SCA患病率高21%相关（比值比：1.21；95%置信区间：1.02 - 1.44），呈线性关系。对MiBP和MnBP观察到正相关但不显著。用原始单位（ng/ml）的邻苯二甲酸盐进行敏感性分析并对尿肌酐进行调整显示结果一致。
MEP暴露与男性工人中SCA患病率增加有关，表明这种邻苯二甲酸盐的暴露可能在心血管疾病早期阶段起作用。这些发现为旨在减少邻苯二甲酸盐暴露以进行心血管疾病一级预防的公共卫生举措提供了依据。
