High levels of a manmade chemical widely used in common household products and detectable in more than 98% of people may increase the risk of cardiovascular (CV) disease and peripheral arterial disease (PAD), according to a study published in Archives of Internal Medicine. (The study was published online in September and will appear in this week’s print edition of Archives.)
Anoop Shankar and colleagues measured serum levels of perfluorooctanoic acid (PFOA) in 1,216 people participating in the National Health and Nutritional Examination Survey (NHANES) and found a strong correlation between PAD and CV disease and PFOA levels. After adjusting for other risk factors, people in the highest quartile of PFOA levels had about double the risk of CV disease and PAD:
- Odds ratio for the top quartile of PFOA: CV disease 2.01 (1.12-3.60), PAD 2.78 (1.03-3.08), CVD or PAD 2.28 (1.40-3.71)
The authors cite several studies that support the plausibility of a harmful effect of PFOA. They duly note the risk of “residual confounding and reverse causality” but write that if their findings are replicated “the population-attributable risk of PFOA exposure on CVD risk could potentially be high.”
In an invited commentary, Debabrata Mukherjee acknowledges the limitations of the study but writes that there is enough biological plausibility in the relationship so that “it would make sense to limit or to eliminate the use of PFOA and its congeners in industry through legislation and regulation while improving water purification and treatment techniques to try and remove this potentially toxic chemical from our water supply.” But, he warns concerns about PFOA “should not dissuade us from aggressively managing known existing risk factors for CVD such as dyslipidemia, smoking, hypertension, diabetes, obesity, and lack of regular physical activity.”
Here is the press release from Archives:
Study Suggests Possible Association Between Cardiovascular Disease, Chemical Exposure
CHICAGO– Exposure to perfluorooctanoic acid (PFOA), a manmade chemical used in the manufacture of some common household products, appears to be associated with cardiovascular disease and peripheral arterial disease in a study of 1,216 individuals, according to a report published Online First by Archives of Internal Medicine, a JAMA Network publication.
Surveys have suggested that PFOA (widely used in the manufacture of products such as lubricants, polishes, paper and textile coatings, and food packaging) is detectable in the blood of more than 98 percent of theU.S.population. Some evidence has suggested that an association may be biologically plausible between PFOA exposure and cardiovascular disease (CVD), according to the study background.
“Cardiovascular disease (CVD) is a major public health problem. Identifying novel risk factors for CVD, including widely prevalent environmental exposures, is therefore important,” according to the study background.
Anoop Shankar, M.D., Ph.D., and colleagues from the West Virginia University School of Public Health, Morgantown, examined the association between serum (blood) levels of PFOA and the presence of CVD and PAD, a marker of atherosclerosis, in a nationally representative group of adults. The study used merged data from the 1999-2000 and 2003-2004 National Health and Nutrition Examination Survey (NHANES).
The study suggests that increasing serum PFOA levels were positively associated with the presence of CVD and PAD, and the association appeared to be independent of confounders such as age, sex, race/ethnicity, smoking status, body mass index, diabetes mellitus, hypertension and serum cholesterol level, the authors comment.
“Our results contribute to the emerging data on health effects of PFCs [perfluoroalkyl chemicals], suggesting for the first time that PFOA exposure is potentially related to CVD and PAD. However, owing to the cross-sectional nature of the present study, we cannot conclude that the association is causal,” the authors comment.
Compared with the reference level of PFOA in quartile 1, the multivariable odds ratio among participants in quartile 4 was 2.01 for CVD and 1.78 for PAD, according to the results.
“In summary, in a representative cross-sectional sample of theU.S.population, we found that higher PFOA levels are positively associated with self-reported CVD and objectively measured PAD. Our findings, however, should be interpreted with caution because of the possibility of residual confounding and reverse causality. Future prospective studies are needed to confirm or refute our findings,” the authors conclude.
(Arch Intern Med. Published online September 3, 2012. doi:10.1001/archinternmed.2012.3393.)
Editor’s Note: This study was supported by a National Clinical Research Program grant from the American Heart Association and grants from the National Institute of Environmental Health Sciences, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Commentary: Perfluorooctanoic Acid Exposure, Cardiovascular Disease
In a commentary, Debabrata Mukherjee, M.D., M.S., of Texas Tech University Health Sciences Center, El Paso, writes: “These results contribute to the evolving data on the adverse health effects of PFOA, suggesting that PFOA exposure may be potentially related to CVD.”
“However, a major limitation is the cross-sectional nature of the study. Given this significant limitation, causality or the temporal nature of the association between PFOA and CVD cannot be concluded from the current analysis,” Mukherjee continues.
“Although it seems clear that additional prospective research is needed to tease out the true adverse cardiovascular effects of PFOA, given the concerns raised by this and prior studies, clinicians will need to act now. From a societal point of view, it would make sense to limit or to eliminate the use of PFOA and its congeners in industry through legislation and regulation while improving water purification and treatment techniques to try and remove this potentially toxic chemical from our water supply,” Mukherjee concludes.
(Arch Intern Med. Published online September 3, 2012. doi:10.1001/archinternmed.2012.3397.)
Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
# # #
Speak Your Mind