Association of Exposure to Perfluoroalkyl Substances and Risk of the Acute Coronary Syndrome: A Case-Control Study in Shijiazhuang Hebei Province
Abstract
Exposures to perfluoroalkyl substances (PFAS) have been reported to increase the risk of atherosclerosis. Therefore, PFAS exposure may be linked to the risk of acute coronary syndrome (ACS), but this association remains uncertain. The objective of the present study was to investigate the association between PFAS exposure and ACS risk through a case-control study. The study included 355 newly diagnosed ACS cases and 355 controls matched by age (within 5 years) and sex. Twelve PFAS were measured in plasma by ultra-high-performance liquid chromatography-tandem mass spectrometry. The conditional logistic regression models were performed to investigate the association between the single and multiple PFAS and ACS risk. Furthermore, we investigated the association of PFAS mixture exposure with ACS risk using a quantile-based g-computation (qgcomp) approach. A mediating effect model was used to assess the mediating effect of platelet indices on the association between PFAS and ACS risk. The results showed that perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) were significantly positively associated with ACS risk in the multiple-PFAS model 2, and this effect was not significant in females. The odds ratios (95% confidence intervals) for PFAS (z-score PFAS) and ACS risk were 1.51 (1.07, 2.15) for PFOA and 1.77 (1.15, 2.72) for PFOS. The dose-response relationships revealed an increasing trend for ACS risk with PFOA and PFOS and decreasing trend for perfluorohexane sulfonic acid (PFHxS) and perfluorodecanoic acid (PFDA). There was no significant correlation between PFAS mixture exposure and ACS risk. Analysis of mediation indicated that platelet count mediated the relationship between PFOS and ACS risk. Our study suggests that higher levels of PFOA and PFOS, and lower levels of PFHxS and PFDA may increase the risk of ACS. However, the reported negative associations should not be considered as protective, and uncertain unresolved confounding may contribute to this result.
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PFASs are associated with metabolic and cardiac effects such as elevated cholesterol/triglycerides, altered electrophysiology, and increased coronary events.
“PFASs have also been associated with metabolic and cardiac effects—such as elevated cholesterol/triglycerides, altered electrophysiology, and increased coronary events [75].”
From Exposure to Per- and Polyfluoroalkyl Substances (PFASs) in Healthcare: Environmental and Clinical Insights (2025) · cites this paper as [75]
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- Authors
- Li, H., Chen, J., Lu, J., Yang, J., Tan, Z., Li, L., Xiao, F., An, Z., Ma, C., Liu, Y., Wang, L., Zhang, X., & Guo, H.
- Affiliations
- Hebei Medical University (CN)
- Second Hospital of Hebei Medical University (CN)
- Corresponding author
- Guo, Huicai
- ORCID
- Venue
- Chemosphere
- Publisher
- Elsevier BV
- Published
- 2023-02
- Volume
- 313
- Pages
- 137464
- ISSN
- 0045-6535 (ISSN-L)
- OpenAlex
- W4311115770
- Cited by
- 35
- References
- 74
- Citations by year
- 2026: 6 · 2025: 13 · 2024: 11 · 2023: 5
- FWCI
- 2.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Chemosphere (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Hebei Province Science and Technology Support Program (19274801D, 21377779D)
- Hebei Province Department of Science And Technology
- National Natural Science Foundation of China (21976050, 82073681)
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Fluorine in Organic Chemistry
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- perfluorinated compounds, acute coronary syndrome, perfluorooctanoic acid, PFOS, perfluorohexane sulfonic acid, perfluorodecanoic acid, platelet count, mediation analysis, dose-response relationship, atherosclerosis
- MeSH terms
- Caprylates, Child, Preschool, Decanoic Acids, Environmental Pollutants, Female, Fluorocarbons, Humans, Sulfonic Acids, Case-Control Studies, Alkanesulfonic Acids, Acute Coronary Syndrome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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