title: Modeled PFOA exposure and coronary artery disease, hypertension, and high cholesterol in community and worker cohorts.
abstract: BACKGROUND
  Several previous studies, mostly cross-sectional, have found associations between perfluorooctanoic acid (PFOA) and high cholesterol levels, but studies of hypertension and heart disease have had inconsistent findings.
  
  
  OBJECTIVE
  In this study we examined the association between modeled PFOA exposure and incident hypertension, hypercholesterolemia, and coronary artery disease among workers at a Mid-Ohio Valley chemical plant that used PFOA, and residents of the surrounding community.
  
  
  METHODS
  Community- and worker-cohort participants completed surveys during 2008-2011 covering demographics, health-related behaviors, and medical history. Cox proportional hazard models, stratified by birth year, modeled the hazard of each outcome (starting at 20 years of age) as a function of retrospective serum PFOA concentration estimates (generated through fate, transport and exposure modeling), controlling for sex, race, education, smoking, alcohol use, body mass index, and diabetes.
  
  
  RESULTS
  Among 32,254 participants (28,541 community; 3,713 worker), 12,325 reported hypertension with medication, 9,909 reported hypercholesterolemia with medication, and 3,147 reported coronary artery disease (2,550 validated). Hypercholesterolemia incidence increased with increasing cumulative PFOA exposure (sum of yearly serum concentration estimates), most notably among males 40-60 years of age. Compared with the lowest exposure quintile (< 142 ng/mL-years), hazard ratios for subsequent quintiles (ng/mL-years: 142 to < 234; 234 to < 630; 630 to < 3,579; ≥ 3,579) were 1.24, 1.17, 1.19, and 1.19 overall and 1.38, 1.32, 1.31, and 1.44 among men 40-60 years of age. There was no apparent association between PFOA exposure and hypertension or coronary artery disease incidence.
  
  
  CONCLUSIONS
  Higher PFOA exposure was associated with incident hypercholesterolemia with medication, but not with hypertension or coronary artery disease.
authors.affiliation: Environmental Health Department, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Winquist
authors.forename: Kyle
authors.initials: K
authors.lastname: Steenland
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000009:adverse effects*; D002210:Caprylates / Q000009:adverse effects*; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004651:Employment; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005466:Fluorocarbons / Q000009:adverse effects*; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology; D012111:Residence Characteristics; D012737:Sex Factors
chemical_list: D000393:Air Pollutants; D002210:Caprylates; D005466:Fluorocarbons; C023036:perfluorooctanoic acid; D002784:Cholesterol