Perfluorooctanoic Acid and Cardiovascular Disease in US Adults

Study Questions:

Are perfluorooctanoic acid (PFOA) (a manmade chemical used in the manufacture of common household consumer products) levels in serum associated with cardiovascular disease (CVD) outcomes among American adults?


Data from the National Health and Nutritional Examination Survey (NHANES, 1999-2000 and 2003-2004) were used for the present analysis. Participants were included who were 40 years or older and had both PFOA levels and ankle-brachial index measured. Participants with missing data on covariates of interest including body mass index (BMI) and cholesterol were excluded. Serum PFOA levels were examined in quartiles. The main outcomes of interest were self-reported CVD, including coronary heart disease and stroke, and objectively measured peripheral arterial disease (PAD). PAD was defined as an ankle-brachial blood pressure index of <0.9.


A total of 1,216 participants were included, of which 51.2% were women. Participants in the highest quartile of PFOA were more likely to be younger age, heavy drinkers, non-Hispanic white, with education levels beyond high school compared to the other participants with lower levels. The highest PFOA quartile was also more likely to have hypertension and higher total cholesterol levels compared to those in the lower quartiles of PFOA levels. Increasing serum PFOA levels were positively associated with CVD and PAD, after adjustment of potential confounders including age, sex, race/ethnicity, smoking status, BMI, diabetes mellitus, hypertension, and serum cholesterol level. Compared with quartile 1 (reference) of PFOA level, the multivariable odds ratio among subjects in quartile 4 was 2.01 (95% confidence interval [CI], 1.12-3.60; p = 0.01 for trend) for CVD and 1.78 (95% CI,1.03-3.08; p = 0.04 for trend) for PAD.


The authors concluded that PFOA is independently associated with both CVD and PAD.


The analysis provided in this study adds to prior studies, suggesting an association between this common chemical and risk for CVD. Further study is warranted to determine whether continued use of PFOA impacts our public health.

Keywords: Odds Ratio, Stroke, Ankle Brachial Index, European Continental Ancestry Group, Coronary Disease, Peripheral Arterial Disease, Risk Factors, Hispanic Americans, Caprylates, Peripheral Vascular Diseases, Smoking, Cholesterol, Body Mass Index, Cardiovascular Diseases, Confidence Intervals, Drugs, Chinese Herbal, Fluorocarbons, Hypertension, United States, Phytotherapy, Diabetes Mellitus

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