title: Urinary bisphenol A concentration and risk of future coronary artery disease in apparently healthy men and women.
abstract: BACKGROUND
  The endocrine-disrupting chemical bisphenol A (BPA) is widely used in food and beverage packaging. Higher urinary BPA concentrations were cross-sectionally associated with heart disease in National Health and Nutrition Examination Survey (NHANES) 2003-2004 and NHANES 2005-2006, independent of traditional risk factors.
  
  
  RESULTS
  We included 758 incident coronary artery disease (CAD) cases and 861 controls followed for 10.8 years from the European Prospective Investigation of Cancer-Norfolk UK. Respondents aged 40 to 74 years and free of CAD, stroke, or diabetes mellitus provided baseline spot urine samples. Urinary BPA concentrations (median value, 1.3 ng/mL) were low. Per-SD (4.56 ng/mL) increases in urinary BPA concentration were associated with incident CAD in age-, sex-, and urinary creatinine-adjusted models (n=1919; odds ratio=1.13; 95% confidence interval, 1.02-1.24; P=0.017). With CAD risk factor adjustment (including education, occupational social class, body mass index category, systolic blood pressure, lipid concentrations, and exercise), the estimate was similar but narrowly missed 2-sided significance (n=1744; odds ratio=1.11; 95% confidence interval, 1.00-1.23; P=0.058). Sensitivity analyses with the fully adjusted model, excluding those with early CAD (<3-year follow-up), body mass index >30, or abnormal renal function or with additional adjustment for vitamin C, C-reactive protein, or alcohol consumption, all produced similar estimates, and all showed associations at P≤0.05.
  
  
  CONCLUSIONS
  Associations between higher BPA exposure (reflected in higher urinary concentrations) and incident CAD during >10 years of follow-up showed trends similar to previously reported cross-sectional findings in the more highly exposed NHANES respondents. Further work is needed to accurately estimate the prospective exposure-response curve and to establish the underlying mechanisms.
authors.affiliation: Epidemiology and Public Health Group, Peninsula College of Medicine and Dentistry, Barrack Road, Exeter, United Kingdom. david.melzer@pms.ac.uk
authors.forename: David
authors.initials: D
authors.lastname: Melzer
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Osborne
authors.forename: William E
authors.initials: WE
authors.lastname: Henley
authors.forename: Riccardo
authors.initials: R
authors.lastname: Cipelli
authors.forename: Anita
authors.initials: A
authors.lastname: Young
authors.forename: Cathryn
authors.initials: C
authors.lastname: Money
authors.forename: Paul
authors.initials: P
authors.lastname: McCormack
authors.forename: Robert
authors.initials: R
authors.lastname: Luben
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Wareham
authors.forename: Tamara S
authors.initials: TS
authors.lastname: Galloway
mesh_terms: D000328:Adult; D000368:Aged; D001559:Benzhydryl Compounds; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000209:etiology / Q000652:urine*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000639:trends*; D010636:Phenols / Q000652:urine*; D011446:Prospective Studies; D012307:Risk Factors; D000098826:Bisphenol A Compounds
chemical_list: D001559:Benzhydryl Compounds; D015415:Biomarkers; D010636:Phenols; C006780:bisphenol A; D000098826:Bisphenol A Compounds