Perfluoroalkyl substances and likelihood of stroke in persons with and without diabetes

Abstract

Objective: The main objective of this study is to evaluate the relationship of perfluoroalkyl substances with stroke and any modifying influence of diabetes. Methods: Data on 3921 adults aged ⩾20 years with and 44,285 without diabetes were drawn from the C8 Health Project. Four perfluoroalkyl substances were investigated: perfluorohexane sulphate, C8 – perfluorooctanoic acid, perfluoroctane sulfonate and perfluorononaoic acid. Results: There were 238 cases of stroke among those with and 643 among those without diabetes. In analyses controlled for age, sex, race, diabetes duration, body mass index, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, C-reactive protein, kidney function and a history of smoking, a history of stroke was significantly inversely associated with serum perfluorohexane sulphate (odds ratio = 0.75, 0.64–0.88) and perfluoroctane sulfonate (odds ratio = 0.81, 0.70–0.90), but not perfluorooctanoic acid (odds ratio = 1.04, 0.94–1.15) or perfluorononaoic acid (odds ratio = 0.89, 0.70–1.14) among those with diabetes. Perfluoroalkyl substances demonstrated no association with stroke among those without diabetes ( p interaction = 0.006 and 0.01 for perfluorohexane sulphate and perfluorooctanoic acid, respectively). Conclusion: In this large cross-sectional study, serum levels of perfluorohexane sulphate and perfluoroctane sulfonate were inversely associated with stroke among those with diabetes. Although mechanisms and implications for this diabetes-specific inverse relationship need to be further explored, our data suggest that perfluoroalkyl substances do not increase risk of stroke among persons with or without diabetes.

Exposure to Perfluoroalkyl Chemicals and Cardiovascular Disease: Experimental and Epidemiological Evidence

“…In a more recent analysis of the C8 Health Project, data were stratified according to the diagnosis of diabetes mellitus: 238 cases of stroke occurred in a total of 3,921 adults with diabetes and 643 cases occurred among 44,285 adults without diabetes. Statistically significant inverse association of stroke with serum PFHxS and PFOS, two compounds not investigated in the previous survey, was observed only considering subjects with diabetes mellitus, while no association was detected in patients without diabetes and exposure to other PFAS (19). According to the authors, a survival bias may exist in that participants with particularly high levels of PFAS in the blood could have died before the beginning of the study.…”

“…The studies so far completed show, however, conflicting results concerning exposure to PFAS and specific cardiovascular events. In fact, Hutcheson et al reported no relation in the whole studied population of 44,285 exposed subjects or inverse relation in a subgroup of diabetic patients and the risk of stroke from the C8 health study (19). Similarly, no clear relation was found between PFAS exposure and the risk of coronary artery disease in a longitudinal case-control study involving male farmers from nine different rural districts in Sweden born during the period 1930-1949 (23).…”

Understanding the Impact of Perfluorinated Compounds on Cardiovascular Diseases and Their Risk Factors: A Meta-Analysis Study

“…From the meta-analysis, PFCs exposure to humans might contribute to the CVDs development (Figure 2), with strong evidence indicating the association of PFCs exposure with their risk factors (Figure 3). The risk of stroke among individuals with and without diabetes was not affected by the increase of PFOS and PFHxS exposure [48]. However, other findings concluded that exposure to PFCs significantly increased the risk of getting CVDs [31][32][33]55].…”

“…The screening excluded 49 articles for the following reason: Thirty were indirectly evaluated the link between PFCs and CVDs, their risk health outcomes and 19 were reporting animal and plant articles. The searches identified fourteen eligible articles using Google Scholar [44,[53][54][55][56][57][58][59][60]66,67,69,70,77], a further four through ScienceDirect [61][62][63][64] and another eleven from PubMed [31,33,[47][48][49]52,55,65,67,73,78]. A review of reference lists revealed two additional eligible publications [68,71].…”

“…Inconsistent findings were observed in previous studies regarding the association of PFCs exposure with CVDs and their risk factors. Four out of eighteen studies had concluded that PFCs exposure is not associated with CVDs and their risk factors [48,58,92] (Table 1). From the meta-analysis, PFCs exposure to humans might contribute to the CVDs development (Figure 2), with strong evidence indicating the association of PFCs exposure with their risk factors (Figure 3).…”