Background: Per- and polyfluoroalkyl substances (PFAS) are widespread environmental contaminants linked to cardiometabolic risk factors, but evidence for associations with clinical cardiovascular disease remains limited, particularly in populations with low exposure. We aimed to evaluate the association of serum linear perfluorooctanoic acid (n-PFOA), a major type of PFAS, with cardiovascular diseases in a recent, nationally representative U.S. sample. Methods: We performed a cross-sectional analysis of 3,516 adults (≥20 years) from the National Health and Nutrition Examination Survey (NHANES) 2015-2018. Survey-weighted logistic regression models were used to assess the association between log-transformed serum n-PFOA and hypertension, coronary heart disease (CHD), myocardial infarction, and congestive heart failure (CHF). Models were adjusted for key sociodemographic, lifestyle, and clinical confounders including age, sex, race/ethnicity, BMI, smoking, diabetes, physical activity, and education. Results: The median survey-weighted serum n-PFOA concentration was 1.4 ng/mL. In fully adjusted models, n-PFOA was not significantly associated with hypertension (OR 1.02 95% CI 0.88-1.18; p = 0.75), CHD (OR 0.75, 95% CI 0.52-1.07; p=0.1), or myocardial infarction (OR 0.8, 95% CI 0.65-1.00; p=0.054). In contrast, higher n-PFOA levels were unexpectedly associated with lower odds of CHF (OR 0.68 95% CI: 0.59- 0.95; p=0.02). Conclusions: In a recent representative sample of the U.S. population, serum n-PFOA concentrations were not associated with hypertension, CHD, or myocardial infarction. The observed inverse association with CHF warrants cautious interpretation and may be attributable to residual confounding from factors like diet or other complex biological mechanisms. These findings highlight the need for longitudinal studies to clarify the evolving role of PFAS in cardiovascular health as environmental exposures decline.
Ose Kadiri (2026) studied this question.