Assessing the impact of volatile organic compounds on cardiovascular health: Insights from the National Health and Nutrition Examination Survey 2011–2020

Volatile organic compounds (VOCs) are environmental pollutants that may negatively impact cardiovascular health. This study investigates the association between VOC mixtures, measured through urinary VOC metabolites (VOCMs), and cardiovascular health using Life's Essential 8 (LE8) scores. Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2020 were analyzed for 2967 adults aged 20-79 years. Multiple statistical methods, including correlation analysis, variance inflation factor (VIF) analysis, quantile g-computation (q-gcomp), and Bayesian kernel machine regression (BKMR), were applied to assess the association between VOCMs and LE8 scores. Sensitivity analyses were conducted with different random seeds and subsampling techniques to confirm robustness. Correlation and VIF analyses revealed strong collinearity among VOCMs, highlighting the need for advanced models. Survey-weighted regression indicated that lower VOC exposure was associated with better cardiovascular health. Q-gcomp identified both positive and negative associations between individual VOCMs and LE8 scores, with some unexpected positive associations. BKMR highlighted the complex mixture effects of VOCMs on cardiovascular health. Sensitivity analyses confirmed the consistency of these findings. This study underscores the intricate relationship between VOC exposure and cardiovascular health and the necessity of advanced statistical methods for mixture analysis. Despite some unexpected findings, the results suggest that VOC exposure, as reflected by urinary VOCMs, is associated with adverse cardiovascular health outcomes. Further research is needed to clarify the biological mechanisms and implications of these associations.