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Abstract
BACKGROUND: Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals widely used since the 1940s for their heat-, water-, and stain-resistant properties. Their persistence in the environment has led to widespread contamination, particularly in drinking water near military and industrial sites, raising concerns about potential health effects. Previous studies have reported associations between PFAS exposure and both elevated blood pressure and cardiovascular disease (CVD), though findings vary by compound and population characteristics.METHODS: This cross-sectional study assessed serum concentrations of four PFAS compounds, PFOS, PFOA, PFHxS, and PFNA, in adults exposed to contaminated drinking water at the Pease International Tradeport. A total of 776 adult participants were enrolled. Associations between PFAS exposure and systolic (SBP), diastolic blood pressure (DBP), hypertension (n=336), and self-reported cardiovascular disease (CVD) (n=32) were evaluated. Participants with pre-existing hypertension or on antihypertensive medication were excluded from incident hypertension analyses. Generalized additive models adjusted for age, sex, BMI, smoking, alcohol use, and education were used to examine relationships between PFAS exposure (by quartiles or tertiles) and each outcome.
RESULTS: Higher serum PFAS levels were modestly associated with increased SBP and DBP, particularly among men. The strongest association was observed between PFHxS and DBP in males (β = 1.31, 95% CI: 0.06–2.57). Associations between PFAS and hypertension were present but not statistically significant. For CVD, participants with disease had higher median levels of PFOS and PFHxS than those without. Although not statistically significant, the strongest association was seen for PFHxS with an odds ratio of 2.92 (95% CI: 0.73–11.66) in the highest tertile.
CONCLUSIONS: Findings suggest that PFAS exposure, especially PFHxS and PFOS, may be associated with increased blood pressure and CVD risk. While most associations were modest and not statistically significant, trends highlight the need for continued research, particularly on understudied PFAS compounds to inform public health policies and reduce exposure-related risks.