Perfluoroalkyl substance mixtures and cardio-metabolic outcomes in highly exposed male workers in the Veneto Region: A mixture-based approach

Erich Batzella; Paolo Girardi; Francesca Russo; Gisella Pitter; Filippo Da Re; Tony Fletcher; Cristina Canova

doi:10.1016/j.envres.2022.113225

Perfluoroalkyl substance mixtures and cardio-metabolic outcomes in highly exposed male workers in the Veneto Region: A mixture-based approach

Environ Res. 2022 Sep;212(Pt A):113225. doi: 10.1016/j.envres.2022.113225. Epub 2022 Apr 4.

Authors

Erich Batzella¹, Paolo Girardi², Francesca Russo³, Gisella Pitter⁴, Filippo Da Re³, Tony Fletcher⁵, Cristina Canova⁶

Affiliations

¹ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padova, Italy.
² Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy & Department of Statistical Sciences, University of Padua, Italy.
³ Regional Directorate of Prevention, Food Safety, and Veterinary Public Health-Veneto Region, Venice, Italy.
⁴ Screening and Health Impact Assessment Unit, Azienda Zero-Veneto Region, Padua, Italy.
⁵ London School of Hygiene and Tropical Medicine, London, United Kingdom.
⁶ Unit of Biostatistics, Epidemiology and Public Health, Department of Cardio-Thoraco-Vascular Sciences and Public Health, Padova, Italy. Electronic address: cristina.canova@unipd.it.

PMID: 35390304
DOI: 10.1016/j.envres.2022.113225

Abstract

Background: Perfluoroalkyl substances (PFAS) have been consistently associated with cardio-metabolic traits. Occupational exposures to multiple PFAS with health outcomes have been poorly investigated. The aim of the present study was to examine these associations among former workers involved in PFAS production.

Methods: We considered 232 male ex-employees who had worked in a factory (Trissino, Veneto Region, Italy), which produced PFAS and other chemicals during 1968-2018. Out of twelve serum PFAS, only four (PFOA, PFOS, PFHxS, and PFNA) were quantifiable in at least 50% of samples. Non-fasting serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured. The associations between serum PFAS mixture and considered outcomes were assessed through linear regression mixed models and Weighted Quantile Sum (WQS) regression, adjusting for potential confounders.

Results: PFOA was detected at the highest level, with a median concentration (in ng/mL) of 80.8 (min-max: 0.35-13,033), followed by PFOS (median: 8.55, min-max: 0.35-343), PFHxS (median: 6.8, min-max: 0.35-597) and PFNA (median: 0.8, min-max: 0.35-5). We observed that each A quartile increase in the WQS index was positively associated with the levels of TC (β: 8.41, 95% IC: 0.78-16.0), LDL-C (β: 8.02, 95% IC: 1-15.0) and SBP (β: 3.21, 95% IC: 0.82-5.60). No association of serum PFAS concentration on HDL cholesterol and DBP emerged. WQS analyses revealed a major contribution of PFNA and PFHxS for the cholesterol levels, although PFOA reported the highest concentration. PFOA and PFOS emerged as chemicals of concern regarding the association with SBP.

Conclusions: The results showed a clear association between serum PFAS levels and markers of cardiovascular risk and support the importance of clinical surveillance of cardiovascular risk factors in population with a high exposure to PFAS, especially in the occupational setting.

Keywords: Cardiometabolic outcomes; Chemical mixtures; Occupational exposure; PFAS; Perfluoroalkyl substances; WQS.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Alkanesulfonic Acids* / adverse effects
Alkanesulfonic Acids* / poisoning
Biomarkers
Blood Pressure
Cholesterol, LDL
Fluorocarbons* / adverse effects
Fluorocarbons* / poisoning
Humans
Italy
Linear Models
Male
Occupational Exposure / adverse effects

Substances

Alkanesulfonic Acids
Biomarkers
Cholesterol, LDL
Fluorocarbons