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Abstract
Ubiquitous environmental exposures increase cardiovascular disease risk via diverse mechanisms. This review examines personal strategies to minimize this risk. With regard to fine particulate air pollution exposure, evidence exists to recommend the use of portable air cleaners and avoidance of outdoor activity during periods of poor air quality. Other evidence may support physical activity, dietary modification, omega-3 fatty acid supplementation, and indoor and in-vehicle air conditioning as viable strategies to minimize adverse health effects. There is currently insufficient data to recommend specific personal approaches to reduce the adverse cardiovascular effects of noise pollution. Public health advisories for periods of extreme heat or cold should be observed, with limited evidence supporting a warm ambient home temperature and physical activity as strategies to limit the cardiovascular harms of temperature extremes. Perfluoroalkyl and polyfluoroalkyl substance exposure can be reduced by avoiding contact with perfluoroalkyl and polyfluoroalkyl substance-containing materials; blood or plasma donation and cholestyramine may reduce total body stores of perfluoroalkyl and polyfluoroalkyl substances. However, the cardiovascular impact of these interventions has not been examined. Limited utilization of pesticides and safe handling during use should be encouraged. Finally, vasculotoxic metal exposure can be decreased by using portable air cleaners, home water filtration, and awareness of potential contaminants in ground spices. Chelation therapy reduces physiological stores of vasculotoxic metals and may be effective for the secondary prevention of cardiovascular disease.
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Affiliation(s)
- Luke J Bonanni
- Grossman School of Medicine (L.J.B.), NYU Langone Health, New York, NY
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2
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Schlezinger JJ, Gokce N. Perfluoroalkyl/Polyfluoroalkyl Substances: Links to Cardiovascular Disease Risk. Circ Res 2024; 134:1136-1159. [PMID: 38662859 PMCID: PMC11047059 DOI: 10.1161/circresaha.124.323697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Conservative estimates by the World Health Organization suggest that at least a quarter of global cardiovascular diseases are attributable to environmental exposures. Associations between air pollution and cardiovascular risk have garnered the most headlines and are strong, but less attention has been paid to other omnipresent toxicants in our ecosystem. Perfluoroalkyl and polyfluoroalkyl substances (PFASs) are man-made chemicals that are extensively used in industrial and consumer products worldwide and in aqueous film-forming foam utilized in firefighting. As such, our exposure to PFAS is essentially ubiquitous. Given the long half-lives of these degradation-resistant chemicals, virtually, all people are carrying a body burden of PFAS. Health concerns related to PFAS are growing such that the National Academies of Sciences, Engineering and Medicine has recommended standards for clinical follow-up of individuals with high PFAS blood levels, including prioritizing screening for dyslipidemia. The link between PFAS and dyslipidemia has been extensively investigated, and evidence for associations is compelling. However, dyslipidemia is not the only cardiovascular risk factor with which PFAS is associated. Here, we review the epidemiological evidence for links between PFAS of concern identified by the National Academies of Sciences, Engineering and Medicine and risk factors for cardiovascular disease, including overweight/obesity, glucose intolerance, hypertension, dyslipidemia, and hyperuricemia. Moreover, we review the potential connections of PFAS with vascular disease and atherosclerosis. While observational data support associations between the National Academies of Sciences, Engineering and Medicine PFAS and selected cardiac risk factors, additional research is needed to establish causation and better understand how exposure to PFAS leads to the development of these conditions.
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Affiliation(s)
| | - Noyan Gokce
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
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3
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Weatherly LM, Shane HL, Jackson LG, Lukomska E, Baur R, Cooper MP, Anderson SE. Systemic and immunotoxicity induced by topical application of perfluorohexane sulfonic acid (PFHxS) in a murine model. Food Chem Toxicol 2024; 186:114578. [PMID: 38458531 DOI: 10.1016/j.fct.2024.114578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are a large group of stable synthetic surfactants that are incorporated into numerous products for their water and oil resistance and have been associated with adverse health effects. The present study evaluated the systemic and immunotoxicity of sub-chronic 28- or 10-day dermal exposure of PFHxS (0.625-5% or 15.63-125 mg/kg/dose) in a murine model. Elevated levels of PFHxS were detected in the serum and urine, suggesting that absorption is occurring through the dermal route. Liver weight (% body) significantly increased and spleen weight (% body) significantly decreased with PFHxS exposure, which was supported by histopathological changes. Additionally, PFHxS significantly reduced the humoral immune response and altered immune subsets in the spleen, suggesting immunosuppression. Gene expression changes were observed in the liver, skin, and spleen with genes involved in fatty acid metabolism, necrosis, and inflammation. Immune-cell phenotyping identified significant decreases in B-cells, NK cells, and CD11b+ monocyte/macrophages in the spleen along with increases in CD4+ and CD8+ T-cells, NK cells, and neutrophils in the skin. These findings support dermal PFHxS-induced liver damage and immune suppression. Overall, data support PFHxS absorption through the skin and demonstrate immunotoxicity via this exposure route, suggesting the need for further examination.
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Affiliation(s)
- Lisa M Weatherly
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA.
| | - Hillary L Shane
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Laurel G Jackson
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Ewa Lukomska
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Rachel Baur
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Madison P Cooper
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Stacey E Anderson
- Allergy and Clinical Immunology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
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Göen T, Abballe A, Bousoumah R, Godderis L, Iavicoli I, Ingelido AM, Leso V, Müller J, Ndaw S, Porras SP, Verdonck J, Santonen T. HBM4EU chromates study - PFAS exposure in electroplaters and bystanders. CHEMOSPHERE 2024; 346:140613. [PMID: 37944767 DOI: 10.1016/j.chemosphere.2023.140613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
The study aims to reveal the exposure to perfluoroalkyl substances (PFAS) in workers in different industry sectors with exposures to hexavalent chromium (Cr(VI)). The PFAS exposure of in total 172 individuals from 4 countries was assessed by the determination of 8 perfluoroalkyl carboxylic acids and 4 perfluoroalkyl sulfonic acids in plasma samples. The participants were 52 chrome plating workers, 43 welders, 3 surface treating workers and 74 workers without any occupational Cr exposure as controls. Significant differences between workers with Cr exposure and controls were found for the perfluoroalkyl sulfonic acids, particularly for perfluorooctane sulfonic acid (PFOS). The median and maximum levels were, respectively, 4.83 and 789 μg/l for chrome plating workers, 4.97 and 1513 μg/l for welders, and 3.65 and 13.9 μg/l for controls. The considerably high PFOS exposure in Cr platers and welders can be explained by the former application of PFOS as mist suppressants in electroplating baths, which resulted in an exposure of the directly involved operators, but also of welders performing maintenance and repair service at these workplaces.
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Affiliation(s)
- Thomas Göen
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Erlangen, Germany.
| | - Annalisa Abballe
- Istituto Superiore di Sanità, Department of Environment and Health, Rome, Italy
| | - Radia Bousoumah
- French National Research and Safety Institute (INRS), Vandœuvre-Lès-Nancy, France
| | - Lode Godderis
- Catholic University Leuven, Centre for Environment and Health, Department of Public Health and Primary Care, Leuven, Belgium; IDEWE, External Service for Prevention and Protection at Work, Heverlee, Belgium
| | - Ivo Iavicoli
- University of Naples Federico II, Department of Public Health, Naples, Italy
| | - Anna Maria Ingelido
- Istituto Superiore di Sanità, Department of Environment and Health, Rome, Italy
| | - Veruscka Leso
- University of Naples Federico II, Department of Public Health, Naples, Italy
| | - Johannes Müller
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Erlangen, Germany
| | - Sophie Ndaw
- French National Research and Safety Institute (INRS), Vandœuvre-Lès-Nancy, France
| | - Simo P Porras
- Finnish Institute of Occupational Health (FIOH), Helsinki, Finland
| | - Jelle Verdonck
- Catholic University Leuven, Centre for Environment and Health, Department of Public Health and Primary Care, Leuven, Belgium
| | - Tiina Santonen
- Finnish Institute of Occupational Health (FIOH), Helsinki, Finland
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Quaid M, Goodrich JM, Calkins MM, Graber JM, Urwin D, Gabriel J, Caban-Martinez AJ, Petroff RL, Grant C, Beitel SC, Littau S, Gulotta JJ, Wallentine D, Hughes J, Burgess JL. Firefighting, per- and polyfluoroalkyl substances, and DNA methylation of genes associated with prostate cancer risk. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2024; 65:55-66. [PMID: 38523457 PMCID: PMC11006564 DOI: 10.1002/em.22589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/26/2024]
Abstract
Prostate cancer is the leading incident cancer among men in the United States. Firefighters are diagnosed with this disease at a rate 1.21 times higher than the average population. This increased risk may result from occupational exposures to many toxicants, including per- and polyfluoroalkyl substances (PFAS). This study assessed the association between firefighting as an occupation in general or PFAS serum levels, with DNA methylation. Only genomic regions previously linked to prostate cancer risk were selected for analysis: GSTP1, Alu repetitive elements, and the 8q24 chromosomal region. There were 444 male firefighters included in this study, with some analyses being conducted on fewer participants due to missingness. Statistical models were used to test associations between exposures and DNA methylation at CpG sites in the selected genomic regions. Exposure variables included proxies of cumulative firefighting exposures (incumbent versus academy status and years of firefighting experience) and biomarkers of PFAS exposures (serum concentrations of 9 PFAS). Proxies of cumulative exposures were associated with DNA methylation at 15 CpG sites and one region located within FAM83A (q-value <0.1). SbPFOA was associated with 19 CpG sites (q < 0.1), but due to low detection rates, this PFAS was modeled as detected versus not detected in serum. Overall, there is evidence that firefighting experience is associated with differential DNA methylation in prostate cancer risk loci, but this study did not find evidence that these differences are due to PFAS exposures specifically.
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Affiliation(s)
- Margaret Quaid
- Department of Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Jaclyn M. Goodrich
- Department of Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Miriam M. Calkins
- National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, USA
| | - Judith M. Graber
- Dept of Biostatistics and Epidemiology, Rutgers the State University of New Jersey, Piscataway, NJ, USA
| | - Derek Urwin
- Los Angeles County Fire Department, Los Angeles, CA, USA
- Dept. of Chemistry & Biochemistry, UCLA, Los Angeles, CA, USA
| | - Jamie Gabriel
- Los Angeles County Fire Department, Los Angeles, CA, USA
| | | | - Rebekah L. Petroff
- Department of Environmental Health Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, USA
| | - Casey Grant
- Fire Protection Research Foundation, Quincy, MA, USA
| | - Shawn C. Beitel
- Dept. of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | - Sally Littau
- Dept. of Community, Environment and Policy, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, AZ, USA
| | | | | | - Jeff Hughes
- Orange County Fire Authority, Irvine, CA, USA
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Purdue MP, Rhee J, Denic-Roberts H, McGlynn KA, Byrne C, Sampson J, Botelho JC, Calafat AM, Rusiecki J. A Nested Case-Control Study of Serum Per- and Polyfluoroalkyl Substances and Testicular Germ Cell Tumors among U.S. Air Force Servicemen. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:77007. [PMID: 37458713 PMCID: PMC10351502 DOI: 10.1289/ehp12603] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are a component of firefighting foams used at military installations. Although high PFAS exposures have been related to cancer risks among civilian populations, the effects for military personnel are unclear. OBJECTIVES We investigated associations between serum PFAS concentrations and testicular germ cell tumors (TGCT) among U.S. Air Force servicemen. METHODS This nested case-control study involved active-duty Air Force servicemen with sera from the Department of Defense Serum Repository. We selected 530 cases and 530 controls individually matched on birth date, race and ethnicity, year entered the service, and year of sample collection, with prediagnostic serum samples collected between 1988 and 2017. A second prediagnostic sample, collected a median of 4 y after the first, was selected for 187 case-control pairs. Seven PFAS were quantified using isotope-dilution tandem mass spectrometry. Odds ratios (ORs) and 95% confidence intervals (CIs) from conditional logistic regression adjusting for military grade, number of deployments, and, in some models, other PFAS, estimated associations between PFAS concentrations (categorized using quartiles among controls) and TGCT. RESULTS Elevated concentrations of some PFAS were observed for military employment in firefighting [perfluorooctanesulfonic acid (PFOS), perfluorohexanesulfonic acid (PFHxS), perfluorooctanoic acid] and service at a base with high PFAS concentrations in drinking water (PFHxS). Elevated PFOS concentrations in the second sample were positively associated with TGCT [OR for fourth vs. first quartile ( OR Q 4 ) = 2.6 , 95% CI: 1.1, 6.4; p trend = 0.02 ], including after adjustment for other PFAS (OR Q 4 = 4.6 , 95% CI: 1.4, 15.1; p trend = 0.009 ). Associations with PFOS in the first/only samples were weak and not statistically significant. Elevated concentrations of perfluorononanoic acid were inversely associated with TGCT, whereas results were null for other PFAS. DISCUSSION We identified service-related predictors of PFAS concentrations and increased TGCT relative risks with elevated PFOS concentrations among Air Force servicemen. These findings warrant further investigation in other populations and military service branches. https://doi.org/10.1289/EHP12603.
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Affiliation(s)
- Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Jongeun Rhee
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Hristina Denic-Roberts
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Celia Byrne
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Joshua Sampson
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Julianne Cook Botelho
- Division of Laboratory Sciences, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Antonia M Calafat
- Division of Laboratory Sciences, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennifer Rusiecki
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
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Gaines LGT, Nylander-French LA. Occupational exposure to PFAS: Research and protection needed. Am J Ind Med 2023; 66:424-426. [PMID: 36748847 DOI: 10.1002/ajim.23467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/08/2023]
Abstract
Per- and polyfluoroalkyl substances (PFAS) have been used in a variety of consumer and industrial applications. PFAS are associated with numerous detrimental health effects, but workplace exposure to PFAS has only been studied in a small number of occupations. More research is needed to fully understand how workers may be exposed to PFAS and what health effects this may cause.
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Affiliation(s)
- Linda G T Gaines
- Office of Superfund Remediation and Technology Innovation, Office of Land and Emergency Management, US Environmental Protection Agency, Washington, District of Columbia, USA
| | - Leena A Nylander-French
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Jung AM, Jahnke SA, Dennis LK, Bell ML, Burgess JL, Farland LV. Firefighter occupational factors and the risk of preterm birth: results from a survey of women firefighters in the USA. Occup Environ Med 2023; 80:77-85. [PMID: 36564180 PMCID: PMC9887375 DOI: 10.1136/oemed-2022-108332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 10/17/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Previous research has suggested that women firefighters may have a greater risk of adverse reproductive outcomes compared with non-firefighting women. In this study, we investigated the association between firefighter occupational factors and risk of preterm birth. METHODS This cross-sectional analysis of US firefighters surveyed in 2017 compared preterm birth among firefighters to non-firefighters using age-at-pregnancy-standardised prevalence ratios. Generalised estimating equations estimated relative risks and 95% CIs between firefighter occupational factors (career or volunteer, wildland status, shift schedule, fire responses, work restriction) and preterm birth risk. We adjusted for age-at-pregnancy, education, gravidity, BMI, and smoking and considered effect modification by age-at-pregnancy and career versus volunteer status. RESULTS Among 934 women who reported 1356 live births, 12% were preterm (n=161). Preterm birth prevalence among firefighters was 1.41 times greater than non-firefighters (95% CI 1.18 to 1.68). Among wildland and combination wildland/structural firefighters, volunteers had 2.82 times the risk of preterm birth (95% CI 1.19 to 6.67) compared with career firefighters. Firefighters who started restricting their work in the 2nd trimester had a nonsignificant 0.67 times lower risk of preterm birth than those who started in the 3rd trimester or did not restrict work at all (95% CI 0.43 to 1.03). CONCLUSIONS Firefighters may have greater risk of preterm birth than non-firefighters, which could be influenced by roles in the fire service and work restrictions taken.
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Affiliation(s)
- Alesia M Jung
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA .,Department of Community, Environment and Policy, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Sara A Jahnke
- Center for Fire Rescue and EMS Health Research, NDRI-USA, Inc, Leawood, Kansas, USA
| | - Leslie K Dennis
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Jefferey L Burgess
- Department of Community, Environment and Policy, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA,Department of Obstetrics and Gynecology, The University of Arizona College of Medicine Tucson, Tucson, Arizona, USA
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