title: Circulating levels of perfluoroalkyl substances (PFASs) and carotid artery atherosclerosis.
abstract: OBJECTIVE
  During recent years, some persistent organic pollutants (POPs) have been linked to atherosclerosis. One group of POPs, the poly- and perfluoroalkyl substances (PFASs) have not been investigated with regard to atherosclerotic plaques.
  
  
  METHODS
  Carotid artery atherosclerosis was assessed by ultrasound in 1016 subjects aged 70 years in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Eight PFASs were detected in >75% of participants' plasma by ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS).
  
  
  RESULTS
  No significant linear associations were observed between the PFASs and intima-media thickness (IMT), or the echogenicity in the intima-media complex (IM-GSM, a marker of lipid infiltration in the artery) when men and women were analyzed together. Neither was occurrence of carotid plaques related to PFASs levels. However, highly significant interactions were observed between some PFASs and sex regarding both IM-GSM and plaque prevalence. Perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA), were all related to IM-GSM in a positive fashion in women (p=0.002-0.003), while these relationships were negative in men. The levels of PFUnDA were significantly related to carotid plaque in women (OR 1.59, 95%CI 1.03-2.43, p=0.03), but not in men (OR 0.93, 95%CI 0.62-1.42, p=0.75).
  
  
  CONCLUSIONS
  In this cross-sectional study, a pronounced gender difference was observed regarding associations between some PFASs, especially the long-chain PFUnDA, and markers of atherosclerosis, with more pronounced relationships found in women. These findings suggest a sex-specific role for PFASs in atherosclerosis.
authors: Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University Uppsala, Sweden. Electronic address: monica.lind@medsci.uu.se.
authors: P Monica
authors: PM
authors: Lind
authors: Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden; MTM Research Centre, School of Science and Technology, Örebro University, Örebro, Sweden. Electronic address: samira.salihovic@medsci.uu.se.
authors: Samira
authors: S
authors: Salihovic
authors: MTM Research Centre, School of Science and Technology, Örebro University, Örebro, Sweden. Electronic address: bert.vanbavel@oru.se.
authors: Bert
authors: B
authors: van Bavel
authors: Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden. Electronic address: lars.lind@medsci.uu.se.
authors: Lars
authors: L
authors: Lind
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000097:blood* / Q000139:chemically induced / Q000453:epidemiology*; D059168:Carotid Intima-Media Thickness; D002851:Chromatography, High Pressure Liquid; D003430:Cross-Sectional Studies; D004785:Environmental Pollutants / Q000097:blood*; D005260:Female; D005466:Fluorocarbons / Q000633:toxicity*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012737:Sex Factors; D013548:Sweden / Q000453:epidemiology; D053719:Tandem Mass Spectrometry
chemical_list: D004785:Environmental Pollutants; D005466:Fluorocarbons
keywords: Atherosclerosis; Atherosclerotic plaques; Poly- and perfluoroalkyl substances (PFASs)