title: Perfluorooctanoic acid and cardiovascular disease in US adults.
abstract: BACKGROUND
  Cardiovascular disease (CVD) is a major public health problem. Identifying novel risk factors for CVD, including widely prevalent environmental exposures, is therefore important. Perfluorooctanoic acid (PFOA) is a manmade chemical used in the manufacture of common household consumer products. Biomonitoring surveys have shown that PFOA is detectable in the blood of more than 98% of the US population. Experimental animal studies suggest that an association between PFOA and CVD is plausible. However, this association in humans has not been previously examined. We therefore examined the independent relationship between serum PFOA levels and CVD outcomes in a representative sample of Americans.
  
  
  METHODS
  We examined 1216 subjects (51.2% women) from the 1999-2003 National Health and Nutritional Examination Survey. Serum PFOA levels were examined in quartiles. The main outcomes of interest were self-reported CVD, including coronary heart disease and stroke, and objectively measured peripheral arterial disease (PAD), defined as an ankle-brachial blood pressure index of less than 0.9.
  
  
  RESULTS
  We found that increasing serum PFOA levels are positively associated with CVD and PAD, independent of confounders such as age, sex, race/ethnicity, smoking status, body mass index, diabetes mellitus, hypertension, and serum cholesterol level. Compared with quartile 1 (reference) of PFOA level, the multivariable odds ratio (95% CI) among subjects in quartile 4 was 2.01 (1.12-3.60; P = .01 for trend) for CVD and 1.78 (1.03-3.08; P = .04 for trend) for PAD.
  
  
  CONCLUSIONS
  Exposure to PFOA is associated with CVD and PAD, independent of traditional cardiovascular risk factors.
authors.affiliation: Department of Epidemiology, West Virginia University School of Public Health, Morgantown, 26506, USA. ashankar@hsc.wvu.edu
authors.forename: Anoop
authors.initials: A
authors.lastname: Shankar
authors.forename: Jie
authors.initials: J
authors.lastname: Xiao
authors.forename: Alan
authors.initials: A
authors.lastname: Ducatman
mesh_terms: D000328:Adult; D002210:Caprylates / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D004781:Environmental Exposure; D005260:Female; D005466:Fluorocarbons / Q000097:blood*; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D014481:United States
chemical_list: D002210:Caprylates; D005466:Fluorocarbons; C023036:perfluorooctanoic acid