Urinary Phenols and Parabens Metabolites with Cardiovascular Disease in United States Adult
Abstract Environmental health has begun to examine the effects of higher-order chemical combinations. The current literature lacks studies exploring associations between multiple organic chemicals mixture and cardiometabolic disease (CVD). This study aimed to evaluate associations between urinary phenol and paraben metabolites and total and individual CVD among a nationally representative sample of adults in the US. This cross-sectional study analyzed 7 urinary chemicals detected among the general population from the 2005–2016 National Health and Nutrition Examination Survey (NHANES, n = 10,428). Multivariate logistic regression and weighted quantile sum (WQS) regression were applied to examine relationships between phenol and paraben metabolites, alone and combined, and total and individual CVD prevalence. WQS regression showed that phenol and paraben indices were independently correlated with total CVD (adjusted odds ratios [OR]: 1.16; 95% confidence interval [CI]:1.06–1.28; P = 0.002), angina (adjusted OR: 1.30; 95% CI: 1.07–1.59; P = 0.009), and heart attack (adjusted OR: 1.30; 95% CI: 1.12–1.51, P < 0.001). Urinary bisphenol A (URBPA, weight = 0.636) was the most heavily weighted component in the total CVD model. Compared with the lowest quartile, URBPA (OR: 1.52; 95% CI: 1.20–1.91; P = 0.001) levels in the highest quartile were independently associated with increased total CVD. Restricted cubic spline regression demonstrated positive correlations and non-linear associations between URBPA and both total CVD (P for nonlinearity = 0.032) and individual CVD (heart attack; P for nonlinearity = 0.031). Our findings suggested that high combined levels of phenols and parabens are associated with an increased CVD risk, with the URBPA contributing the highest risk.