Conservative estimates by the World Health Organization suggest that at least a quarter of global cardiovascular diseases are attributable to environmental exposures. Associations between air pollution and cardiovascular risk have garnered the most headlines and are strong, but less attention has been paid to other omnipresent toxicants in our ecosystem. Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are man-made chemicals that are extensively used in industrial and consumer products worldwide and in aqueous film-forming foam utilized in firefighting. As such, our exposure to PFAS is essentially ubiquitous. Given the long half-lives of these degradation-resistant chemicals, virtually, all people are carrying a body burden of PFAS. Health concerns related to PFAS are growing such that the National Academies of Sciences, Engineering and Medicine has recommended standards for clinical follow-up of individuals with high PFAS blood levels, including prioritizing screening for dyslipidemia. The link between PFAS and dyslipidemia has been extensively investigated, and evidence for associations is compelling. However, dyslipidemia is not the only cardiovascular risk factor with which PFAS is associated. Here, we review the epidemiological evidence for links between PFAS of concern identified by the National Academies of Sciences, Engineering and Medicine and risk factors for cardiovascular disease, including overweight/obesity, glucose intolerance, hypertension, dyslipidemia, and hyperuricemia. Moreover, we review the potential connections of PFAS with vascular disease and atherosclerosis. While observational data support associations between the National Academies of Sciences, Engineering and Medicine PFAS and selected cardiac risk factors, additional research is needed to establish causation and better understand how exposure to PFAS leads to the development of these conditions.

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全氟烷基/多氟烷基物质：与心血管疾病风险的联系

世界卫生组织的保守估计表明，全球至少四分之一的心血管疾病可归因于环境暴露。空气污染与心血管风险之间的联系占据了最多的头条新闻，而且联系也很紧密，但我们生态系统中其他无所不在​​的有毒物质却很少受到关注。全氟烷基和多氟烷基物质 (PFAS) 是人造化学品，广泛用于全球工业和消费品以及消防用水成膜泡沫中。因此，我们接触 PFAS 的情况基本上是无处不在的。鉴于这些抗降解化学物质的半衰期较长，几乎所有人的体内都承受着 PFAS 的负担。与 PFAS 相关的健康问题日益严重，因此美国国家科学院、工程院和医学院推荐了对 PFAS 血液水平高的个体进行临床随访的标准，包括优先筛查血脂异常。 PFAS 与血脂异常之间的联系已得到广泛研究，相关证据令人信服。然而，血脂异常并不是与 PFAS 相关的唯一心血管危险因素。在此，我们回顾了美国国家科学院、工程院和医学院确定的 PFAS 与心血管疾病危险因素（包括超重/肥胖、葡萄糖耐受不良、高血压、血脂异常和高尿酸血症）之间联系的流行病学证据。此外，我们回顾了 PFAS 与血管疾病和动脉粥样硬化的潜在联系。虽然观察数据支持美国国家科学院、工程院和医学院 PFAS 与选定的心脏危险因素之间的关联，但仍需要进行更多研究来确定因果关系并更好地了解 PFAS 暴露如何导致这些疾病的发生。