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Exposure to environmental chemical PFAS may not increase CHD risk for adults with diabetes
Exposure to perfluoroalkyl substances may not increase the risk for coronary heart disease in adults with diabetes, according to findings published in the Journal of Diabetes and its Complications.
“There is a lot of press out about the adverse health effects of PFCs, aka, perfluorocarbons or PFAS,” Baqiyyah N. Conway, PhD, assistant professor of community health in the department of epidemiology and biostatistics in the School of Rural and Community Health at the University of Texas Health Science Center in Tyler, Texas, told Endocrine Today. “Some of this is accurate and some of this is publication bias where only statistically significant findings are published, and when it relates to exposures where popular professional opinion is that it is thought to be harmful, by and large findings showing an adverse relationship are much more likely to get published.”
Conway and colleagues conducted a cross-sectional study of 5,270 adults with diabetes who were included in the C8 Health Project, which is a health survey that collected data from individuals in West Virginia and Ohio who may have been exposed to PFAS through water contamination between 1950 and 2004.
In the survey, CHD and diabetes were confirmed by self-report or clinical diagnosis. Among the total cohort, 1,489 participants had CHD (mean age, 64.2 years; 39.9% women) and 3,781 did not (mean age, 55.3 years; 54.7% women).
The researchers found an inverse association between all PFAS and CHD, including perfluorohexane sulfonate (OR = 0.81; 95% CI, 0.78-0.84), perfluorooctanoic acid (OR = 0.91; 95% CI, 0.89-0.93), perfluorooctane sulfonate (OR = 0.85; 95% CI, 0.82-0.89) and perfluorononanoic acid (OR = 0.83; 95% CI, 0.78-0.88). This association held after the researchers controlled for diabetes duration, BMI, HDL cholesterol, LDL cholesterol, white blood cell count, estimated glomerular filtrate rate, uric acid, hemoglobin and iron, particularly in perfluorohexane sulfonate (OR = 0.72; 95% CI, 0.65-0.79), perfluorooctanoic acid (OR = 0.9; 95% CI, 0.85-0.96) and perfluorooctane sulfonate (OR = 0.9; 95% CI, 0.81-0.99), which all retained a statistically significant association.
To further confirm the inverse association, the researchers divided participants into five quintiles of PFAS measurements. CHD odds decreased with each increase in quintile, ultimately reaching their lowest mark in the fifth quintile of perfluorohexane sulfonate (OR = 0.45; 95% CI, 0.34-0.58), perfluorooctanoic acid (OR = 0.73; 95% CI, 0.57-0.94), perfluorooctane sulfonate (OR = 0.71; 95% CI, 0.55-0.92) and perfluorononanoic acid (OR = 0.81; 95% CI, 0.62-1.05).
Lastly, the researchers examined the association between PFAS and CHD when controlled for chronic kidney disease in the 22% of the study population with CKD, but they did not find a significant interaction between CKD and PFAS.
“Patients and physicians should not be alarmed about PFCs, aka, perfluorocarbons or PFAS, raising the risk of heart disease,” Conway said. “It does not appear to increase this risk, and this is particularly so among persons with diabetes. A word of caution, however: Though nature abounds with toxins that have therapeutic value, physicians and patients should not purposely expose themselves to PFAS or other toxins based on the findings of one study or in an off-label manor.” – by Phil Neuffer
Disclosures: Conway reports no relevant financial disclosures. Please see study for all other authors’ relevant financial disclosures.