title: The association of urinary polycyclic aromatic hydrocarbon biomarkers and cardiovascular disease in the US population.
abstract: BACKGROUND
  Polycyclic aromatic hydrocarbons (PAHs) are potent atmospheric pollutants produced by incomplete combustion of organic materials. Pre-clinical and occupational studies have reported a positive association of PAHs with oxidative stress, inflammation and subsequent development of atherosclerosis, a major underlying risk factor for cardiovascular disease (CVD). The aim of the current study is to estimate the association between levels of PAH biomarkers and CVD in a national representative sample of United States (US) adults.
  
  
  METHODS
  We examined adult participants (≥20years of age) from the merged US National Health and Nutrition Examination Survey 2001-2010. Logistic regression models were used to estimate the associations of each urinary PAH biomarker and CVD. Post-exploratory structural equation modeling was then used to address the interdependent response variables (angina, heart attack, stroke and coronary heart disease) as well as the interdependencies of PAH biomarkers.
  
  
  RESULTS
  PAH biomarkers were positively associated with cardiovascular disease in multiple logistic regression models, although some associations were not statistically robust. Using structural equation modeling, latent PAH exposure variable was positively associated with latent CVD level variable in the multivariable adjusted model (β=0.12; 95% CI: 0.03, 0.20).
  
  
  CONCLUSIONS
  A modest association between levels of PAH biomarkers and CVD was detected in US adults. Further prospective studies with adequate sample size are needed to replicate or refute our findings.
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI 48824, United States. Electronic address: oalshaarawy@epi.msu.edu.
authors.forename: Omayma
authors.initials: O
authors.lastname: Alshaarawy
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI 48109, United States.
authors.forename: Hosam A
authors.initials: HA
authors.lastname: Elbaz
authors.affiliation: Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV 26506, United States.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Andrew
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000652:urine; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000652:urine*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009749:Nutrition Surveys; D018384:Oxidative Stress / Q000187:drug effects; D011084:Polycyclic Aromatic Hydrocarbons / Q000652:urine*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D011084:Polycyclic Aromatic Hydrocarbons
keywords: Cardiovascular disease; NHANES; Polycyclic aromatic hydrocarbons; Structural equation modeling