Association of exposure to perfluoroalkyl substances and risk of the acute coronary syndrome: A case-control study in Shijiazhuang Hebei Province

Exposures to perfluoroalkyl substances (PFAS) have been reported to increase the risk of atherosclerosis. Therefore, PFAS exposure may be linked to the risk of acute coronary syndrome (ACS), but this association remains uncertain. The objective of the present study was to investigate the association between PFAS exposure and ACS risk through a case-control study. The study included 355 newly diagnosed ACS cases and 355 controls matched by age (within 5 years) and sex. Twelve PFAS were measured in plasma by ultra-high-performance liquid chromatography-tandem mass spectrometry. The conditional logistic regression models were performed to investigate the association between the single and multiple PFAS and ACS risk. Furthermore, we investigated the association of PFAS mixture exposure with ACS risk using a quantile-based g-computation (qgcomp) approach. A mediating effect model was used to assess the mediating effect of platelet indices on the association between PFAS and ACS risk. The results showed that perfluorooctanoic acid (PFOA) and perfluorooctanesulfonic acid (PFOS) were significantly positively associated with ACS risk in the multiple-PFAS model 2, and this effect was not significant in females. The odds ratios (95% confidence intervals) for PFAS (z-score PFAS) and ACS risk were 1.51 (1.07, 2.15) for PFOA and 1.77 (1.15, 2.72) for PFOS. The dose-response relationships revealed an increasing trend for ACS risk with PFOA and PFOS and decreasing trend for perfluorohexane sulfonic acid (PFHxS) and perfluorodecanoic acid (PFDA). There was no significant correlation between PFAS mixture exposure and ACS risk. Analysis of mediation indicated that platelet count mediated the relationship between PFOS and ACS risk. Our study suggests that higher levels of PFOA and PFOS, and lower levels of PFHxS and PFDA may increase the risk of ACS. However, the reported negative associations should not be considered as protective, and uncertain unresolved confounding may contribute to this result.