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Per- and polyfluoroalkyl substances and calcifications of the coronary and aortic arteries in adults with prediabetes: Results from the diabetes prevention program outcomes study
Environment International ( IF 7.577 ) Pub Date : 2021-02-22 , DOI: 10.1016/j.envint.2021.106446
Citlalli Osorio-Yáñez; Marco Sanchez-Guerra; Andres Cardenas; Pi-I. D. Lin; Russ Hauser; Diane R. Gold; Ken P. Kleinman; Marie-France Hivert; Abby F. Fleisch; Antonia M. Calafat; Thomas F. Webster; Edward S. Horton; Emily Oken

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 (<10), moderate (11–400) and severe (>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.



中文翻译:

患有糖尿病的成年人的全氟和多氟烷基物质以及冠状动脉和主动脉钙化:糖尿病预防计划结果研究的结果

背景

全氟烷基物质和多氟烷基物质(PFAS)是破坏内分泌的化学物质,与心血管疾病的危险因素有关,包括体重增加和高胆固醇血症。因此,PFAS可能有助于动脉粥样硬化和心血管疾病(CVD)的发展。但是,以前没有研究评估PFAS暴露与动脉钙化之间的关系。

方法与结果

这项研究使用了参加糖尿病预防计划试验的666名糖尿病前期成年人的数据,这些成年人在基线和随机分组后的两年内在血浆中定量了6种PFAS,并测量了冠状动脉钙(CAC)和升(AsAC)和降(DAC) )基线后13–14年胸主动脉钙化。我们进行了多项回归分析,以测试根据Agatston评分[低(<10),中度(11-400)和严重(> 400)]分类的PFAS和CAC之间的关联。我们使用逻辑回归来评估PFAS与AsAC和DAC的存在之间的关联。我们针对基线性别,年龄,BMI,种族/民族,吸烟,教育,治疗分配(安慰剂或生活方式干预)和他汀类药物的使用情况调整了模型。PFAS浓度类似于国家平均值;53。9%的参与者的CAC> 11,7.7%的人具有AsAC,42.6%的人具有DAC。全氟辛烷磺酸(PFOS)的线性和支链异构体的血浆平均浓度的总和每增加一倍,严重和低度CAC的可能性比就高1.49倍(95%CI:1.01、2.21)。这种关联主要是由线性(n-PFOS)异构体驱动的[重度CAC与低度CAC的几率分别为1.54(95%CI:1.05,2.25)]。平均血浆N-乙基-全氟辛烷磺酰胺基乙酸浓度的每增加一倍,与CAC发生几率的相关性就呈剂量依赖性[对于中度CAC,OR = 1.26(95%CI:1.08,1.47),而OR = 1.37(95%)重度CAC与低度CAC相比,CI:1.07,1.74)]。平均血浆PFOS和n-PFOS也与AsAC的几率相关[分别为OR = 1.67(95%CI:1.10,2.54)和OR = 1.70(95%CI:1.13,2.56)],但不是DAC。其他PFAS与结果无关。

结论

选择血浆中PFAS的血浆浓度较高的糖尿病前成年人冠状动脉和胸主动脉钙化的风险较高。PFAS暴露可能是高危人群中心血管健康不良的危险因素。

更新日期:2021-02-22
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