标题：Per- and polyfluoroalkyl substances and calcifications of the coronary and aortic arteries in adults with prediabetes: Results from the diabetes prevention program outcomes study
摘要：Background Per- and polyfluoroalkyl substances (PFAS) are endocrine disrupting chemicals that have been associated with cardiovascular risk factors including elevated body weight and hypercholesterolemia. Therefore, PFAS may contribute to the development of atherosclerosis and cardiovascular disease (CVD). However, no previous study has evaluated associations between PFAS exposure and arterial calcification. Methods and results This study used data from 666 prediabetic adults enrolled in the Diabetes Prevention Program trial who had six PFAS quantified in plasma at baseline and two years after randomization, as well as measurements of coronary artery calcium (CAC) and ascending (AsAC) and descending (DAC) thoracic aortic calcification 13–14 years after baseline. We performed multinomial regression to test associations between PFAS and CAC categorized according to Agatston score [low (400)]. We used logistic regression to assess associations between PFAS and presence of AsAC and DAC. We adjusted models for baseline sex, age, BMI, race/ethnicity, cigarette smoking, education, treatment assignment (placebo or lifestyle intervention), and statin use. PFAS concentrations were similar to national means; 53.9% of participants had CAC > 11, 7.7% had AsAC, and 42.6% had DAC. Each doubling of the mean sum of plasma concentrations of linear and branched isomers of perfluorooctane sulfonic acid (PFOS) was associated with 1.49-fold greater odds (95% CI: 1.01, 2.21) of severe versus low CAC. This association was driven mainly by the linear (n-PFOS) isomer [1.54 (95% CI: 1.05, 2.25) greater odds of severe versus low CAC]. Each doubling of mean plasma N-ethyl-perfluorooctane sulfonamido acetic acid concentration was associated with greater odds of CAC in a dose-dependent manner [OR = 1.26 (95% CI:1.08, 1.47) for moderate CAC and OR = 1.37 (95% CI:1.07, 1.74) for severe CAC, compared to low CAC)]. Mean plasma PFOS and n-PFOS were also associated with greater odds of AsAC [OR = 1.67 (95% CI:1.10, 2.54) and OR = 1.70 (95% CI:1.13, 2.56), respectively], but not DAC. Other PFAS were not associated with outcomes. Conclusions Prediabetic adults with higher plasma concentrations of select PFAS had higher risk of coronary and thoracic aorta calcification. PFAS exposure may be a risk factor for adverse cardiovascular health among high-risk populations.
关键词：PFAS ; Coronary artery calcium ; Ascending thoracic aortic calcification ; Descending thoracic aortic calcification ; DPP ; DPPOS ; PFAS Per- and polyfluoroalkyl substances ; CAC coronary artery calcium ; AsAC ascending thoracic aortic calcification ; DAC descending thoracic aortic calcification ; PFOS perfluorooctane sulfonic acid (sum of linear and branched isomers) ; n-PFOS linear perfluorooctane sulfonic acid ; Sm-PFOS perfluoromethylheptane sulfonic acids ; PFOA perfluorooctanoic acid (sum of linear and branched isomers) ; n-PFOA linear perfluorooctanoic acid ; Sb-PFOA branched perfluorooctanoic acids ; PFHxS perfluorohexane sulfonic acid ; EtFOSAA N-ethyl-perfluorooctane sulfonamido acetic acid ; MeFOSAA N-methyl-perfluorooctane sulfonamido acetic acid ; PFNA perfluorononanoic acid ; DPPOS Diabetes Prevention Program Outcomes Study ; BMI body mass index
