Common endocrine-disrupting chemicals may drive incident hypertension in midlife women
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Women exposed to higher concentrations of a class of endocrine-disrupting chemicals known as perfluoroalkyl and polyfluoroalkyl substances are at increased risk for incident hypertension, researchers reported.
Data show human exposure to perfluoroalkyl and polyfluoroalkyl substances (PFAS) may be associated with higher risk for CVD and peripheral artery disease, as well as several CVD risk factors including thyroid disease, elevated total cholesterol and LDL, higher BMI and altered glucose homeostasis, Sung Kyun Park, ScD, MPH, associate professor of epidemiology at the University of Michigan School of Public Health, and colleagues wrote in Hypertension.
“PFAS are forever chemicals as well as everywhere chemicals,” Park told Healio. “Diet and everyday products are the major sources. PFAS exposure is related to ‘convenience.’ Nonstick cookware, food wrappers, nongreasy papers and other food contact materials contain PFAS. Waterproof and stain-proof fabrics contain PFAS. Some cosmetics, for example, waterproof mascara, also contain PFAS. Drinking water is also an important source of PFAS exposure. Our findings suggest that long-term cumulative PFAS exposure, even before midlife, may increase the risk for high BP and, therefore, the benefit of reducing the population exposure to PFAS and potential preventions of hypertension and other health conditions would be enormous.”
Assessing PFAS exposure
Park and colleagues analyzed data from 1,058 midlife women free from hypertension at baseline who participated in Study of Women’s Health Across the Nation (SWAN), with annual follow-up visits between 1999 and 2017 (median age, 49 years; 54.5% white; 30% postmenopausal). The SWAN Multi-Pollutant Study was initiated in 2016 to examine metabolic and reproductive health effects of multiple environmental pollutants, including PFAS, in midlife women. Researchers assessed samples from the third SWAN follow-up (1999-2000) for environmental exposure assessments.
Information on BP and antihypertensive medication was collected at each visit; researchers defined hypertension as systolic BP of at least 140 mm Hg or diastolic BP of at least 90 mm Hg or receiving antihypertensive treatment. Researchers analyzed baseline serum samples for concentrations of perfluorohexane sulfonate (PFHxS), linear perfluorooctane sulfonate (n-PFOS), linear perfluorooctanoate (n-PFOA), perfluorononanoate, perfluorodecanoate, perfluoroundecanoate, perfluorododecanoate, 2-(N-ethyl-perfluorooctane sulfonamido) acetate (EtFOSAA) and 2-(N-methyl-perfluorooctane sulfonamido) acetate (MeFOSAA).
Within the cohort, the median serum concentrations of PFAS at baseline were 24.1 ng/mL for PFOS, 17.2 ng/mL for n-PFOS, 7.1 ng/mL for sum of branched isomers of PFOS, 4.1 ng/mL for n-PFOA, 1.5 ng/mL for PFHxS, 0.6 ng/mL for perfluorononanoate, 1.2 ng/mL for EtFOSAA, and 1.4 ng/mL for MeFOSAA.
During median follow-up of 12.4 years, 470 participants developed incident hypertension at a rate of 40.1 cases per 1,000 person-years.
Researchers found positive associations of PFOS, n-PFOA and EtFOSAA with hypertension incidence. Compared with the lowest tertile of serum PFOS concentrations, women with the highest concentration of PFOS were 42% more likely to develop hypertension (HR = 1.42; 95% CI, 1.19-1.68; P for trend < .0001), whereas women with the highest concertation of n-PFOA and EtFOSAA were 47% (HR = 1.47; 95% CI, 1.24-1.75; P for trend < .0001) and 42% (HR = 1.42; 95% CI, 1.19-1.7; P for trend = .0003), respectively, more likely to develop hypertension compared with those with the lowest concentrations. Results persisted after adjustment for race, study site, education, financial strain, smoking status and alcohol intake, total calorie intake and menopausal status.
In the mixture analysis, women in the highest tertile of overall PFAS concentrations were 71% more likely to develop incident hypertension compared with women in the lowest tertile (adjusted HR = 1.71; 95% CI, 1.15-2.54; P for trend = .008).
Reducing exposure, reducing CV risk
“We still do not understand how PFAS affects BP, though there are a few mechanisms proposed,” Ning Ding, PhD, a postdoctoral research fellow at the University of Michigan School of Public Health, told Healio. “We need more research on biological mechanisms. In our study, we examined only a few well-known and abundant PFAS compounds. However, a number of different PFAS, including alternatives of legacy PFAS, short-chain PFAS, are used in consumer products, and people are potentially exposed to those chemicals. We do not know the toxicity of such chemicals.”
The authors also noted that the findings suggest PFAS are potentially modifiable risk factors for hypertension.
“If confirmed in future studies, these findings suggest that understanding human exposure to PFAS and developing effective strategies to reduce PFAS exposure may help prevent the development of hypertension and thereby reduce the global burden of CVD,” the researchers wrote.
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