Perfluoroalkyl/polyfluoroalkyl substances: Links to cardiovascular disease risk
Open accessAbstract
Conservative estimates by the World Health Organization suggest that at least a quarter of global cardiovascular diseases are attributable to environmental exposures. Associations between air pollution and cardiovascular risk have garnered the most headlines and are strong, but less attention has been paid to other omnipresent toxicants in our ecosystem. Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are man-made chemicals that are extensively used in industrial and consumer products worldwide and in aqueous film-forming foam utilized in firefighting. As such, our exposure to PFAS is essentially ubiquitous. Given the long half-lives of these degradation-resistant chemicals, virtually, all people are carrying a body burden of PFAS. Health concerns related to PFAS are growing such that the National Academies of Sciences, Engineering and Medicine has recommended standards for clinical follow-up of individuals with high PFAS blood levels, including prioritizing screening for dyslipidemia. The link between PFAS and dyslipidemia has been extensively investigated, and evidence for associations is compelling. However, dyslipidemia is not the only cardiovascular risk factor with which PFAS is associated. Here, we review the epidemiological evidence for links between PFAS of concern identified by the National Academies of Sciences, Engineering and Medicine and risk factors for cardiovascular disease, including overweight/obesity, glucose intolerance, hypertension, dyslipidemia, and hyperuricemia. Moreover, we review the potential connections of PFAS with vascular disease and atherosclerosis. While observational data support associations between the National Academies of Sciences, Engineering and Medicine PFAS and selected cardiac risk factors, additional research is needed to establish causation and better understand how exposure to PFAS leads to the development of these conditions.
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PFAS exposure affects lipid metabolism, including cholesterol, and is linked to cardiovascular disease, with high risk in adults.
“| Lipid Metabolism | Affects cholesterol, linked to cardiovascular disease. | High | Adults | Long-term cardiovascular effects | [228] |”
From Industrial Applications, Environmental Fate, Human Exposure, and Health Effects of PFAS (2025) · cites this paper as [228]
The Dyslipidemia and atherosclerosis section reports associations between several PFAS and higher total cholesterol and LDL-C, and identifies PFOS as having the strongest evidence for an association with atherosclerosis and cardiovascular disease risk. The Conclusions section describes clinical cardiovascular disease as a potential concern and calls for further research on causality. It does not establish the table’s categorical “High” risk rating for adults or definite long-term cardiovascular effects. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAdults and the elderly are more vulnerable to metabolic, cardiovascular, and bone diseases from PFAS exposure.
“adults and the elderly are more vulnerable to metabolic, cardiovascular, and bone diseases.”
From Industrial Applications, Environmental Fate, Human Exposure, and Health Effects of PFAS (2025) · cites this paper as [228]
The 'PFAS AND CVD RISK FACTORS' section focuses on adults, and the Conclusions associate PFAS exposure with hypertension, hypercholesterolemia and hyperuricemia. The paper does not establish that adults or elderly people are more vulnerable than other age groups, and the passages found do not address bone disease. It also calls for further research on whether PFAS cause the reported outcomes. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPFAS exposure is linked to hypertension but not coronary heart disease, with moderate risk in adults.
“| Cardiovascular Health | Linked to hypertension but not coronary heart disease. | Moderate | Adults | Long-term cardiovascular issues | [228] |”
From Industrial Applications, Environmental Fate, Human Exposure, and Health Effects of PFAS (2025) · cites this paper as [228]
The Blood pressure and hypertension section reports that most studies associate PFAS with increased hypertension risk. The Dyslipidemia and atherosclerosis section reports no association between PFOA and coronary artery disease in one study, but also reports increased acute coronary syndrome risk with several PFAS; it does not support a blanket claim of no coronary heart disease link. The cited passages do not establish a 'moderate' risk level for adults. (LLM, conf=0.88)
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- Authors
- Schlezinger, J. J., & Gokce, N.
- Affiliations
- Boston University (US)
- Venue
- Circulation Research
- Published
- 2024-04-26
- Volume
- 134
- Issue
- 9
- Pages
- 1136-1159
- ISSN
- 0009-7330 (ISSN-L)
- 1524-4571
- PMC
- PMC11047059
- OpenAlex
- W4395447637
- Cited by
- 103
- References
- 152
- Citations by year
- 2026: 49 · 2025: 42 · 2024: 12
- FWCI
- 3.30
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Circulation Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- Funders
- U.S. Department of Defense
- National Institutes of Health
- National Heart, Lung, and Blood Institute (R01HL142650)
- National Institute of Environmental Health Sciences (R21ES034939)
- Topics
- Physical Sciences › Environmental Science › Environmental Chemistry › Per- and polyfluoroalkyl substances research
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmaceutical Science › Fluorine in Organic Chemistry
- Physical Sciences › Materials Science › Polymers and Plastics › Synthesis and properties of polymers
- Keywords
- per- and polyfluoroalkyl substances, PFAS, cardiovascular risk, dyslipidemia, obesity, impaired glucose tolerance, hypertension, hyperuricemia, atherosclerosis, vascular disease, environmental toxins, screening guidelines
- MeSH terms
- Animals, Cardiovascular Diseases, Environmental Exposure, Fluorocarbons, Humans, Risk Factors, Dyslipidemias
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