Abstract
Environmental phenols, as endocrine disruptors, are used widely in personal care and consumer products. However, few studies have examined the association between phenol exposure, including bisphenol A (BPA), benzophenone-3 (BP-3), and triclosan, and the prevalence of cardiovascular diseases (CVD). This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2003–2012). Urinary BPA, BP-3, and triclosan were measured with liquid chromatography-tandem mass spectrometry (HPLC–MS/MS). The CVD was defined as a composite of 5 self-reported cardiovascular outcomes, including congestive heart failure, coronary heart disease, angina pectoris, heart attack or stroke. Multivariable logistic regression models were used to examine the association between phenols and the prevalence of CVD. A total of 8164 participants were enrolled, and 740 (9.1%) were diagnosed of CVD. The average levels of BPA, BP-3, and triclosan concentrations were 3.38, 202.63, and 99.27 ng/mL respectively. Per 1-unit increasement in log-transformed urinary BPA was associated with increased risk of CVD after adjusting all covariates (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.01 to 1.18, P < 0.05). Compared with the lowest quartile (< 0.9), the multivariable-adjusted OR was 1.30 (1.03 to 1.65, P < 0.05) in the highest quartile (> 3.8). Restricted spline models confirmed that the association between BPA and the risk of CVD was non-linear (P = 0.045). Only BPA was associated with the risk of CVD, following a J-curve shaped relationship.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11356-021-18323-3/MediaObjects/11356_2021_18323_Fig1_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs11356-021-18323-3/MediaObjects/11356_2021_18323_Fig2_HTML.png)
Similar content being viewed by others
Data availability
The original data can be obtained from NHANES (https://www.cdc.gov/nchs/nhanes/index.htm).
References
Apaydin FG, Aslanturk A, Uzunhisarcikli M, Bas H, Kalender S, Kalender Y (2019) Histopathological and biochemical studies on the effect of curcumin and taurine against bisphenol A toxicity in male rats. Environ Sci Pollut Res Int 26(12):12302–12310. https://doi.org/10.1007/s11356-019-04578-4
Cai S, Rao X, Ye J, Ling Y, Mi S, Chen H et al (2020) Relationship between urinary bisphenol a levels and cardiovascular diseases in the U.S. adult population, 2003–2014. Ecotoxicol Environ Saf 192:110300. https://doi.org/10.1016/j.ecoenv.2020.110300
Chowdhury R, Ramond A, O’Keeffe LM, Shahzad S, Kunutsor SK, Muka T et al (2018) Environmental toxic metal contaminants and risk of cardiovascular disease: systematic review and meta-analysis. BMJ 362:k3310. https://doi.org/10.1136/bmj.k3310
Cortesi PA, Fornari C, Madotto F, Conti S, Naghavi M, Bikbov B et al (2020) Trends in cardiovascular diseases burden and vascular risk factors in Italy: The Global Burden of Disease study 1990-2017. Eur J Prev Cardiol 28(4):385–396. https://doi.org/10.1177/2047487320949414
Cullinan MP, Palmer JE, Carle AD, West MJ, Westerman B, Seymour GJ (2015a) The influence of a triclosan toothpaste on adverse events in patients with cardiovascular disease over 5-years. Sci Total Environ 508:546–552. https://doi.org/10.1016/j.scitotenv.2014.11.052
Cullinan MP, Palmer JE, Faddy MJ, Westerman B, Carle AD, West MJ et al (2015b) The influence of triclosan on biomarkers of cardiovascular risk in patients in the Cardiovascular and Periodontal Study (CAPS): a randomized controlled trial. J Periodontol 86(7):847–855. https://doi.org/10.1902/jop.2015.140716
Dallio M, Masarone M, Errico S, Gravina AG, Nicolucci C, Di Sarno R et al (2018) Role of bisphenol A as environmental factor in the promotion of non-alcoholic fatty liver disease: in vitro and clinical study. Aliment Pharmacol Ther 47(6):826–837. https://doi.org/10.1111/apt.14499
Fu X, Xu J, Zhang R, Yu J (2020) The association between environmental endocrine disruptors and cardiovascular diseases: a systematic review and meta-analysis. Environ Res 187:109464. https://doi.org/10.1016/j.envres.2020.109464
Guzik TJ, Touyz RM (2017) Oxidative stress, inflammation, and vascular aging in hypertension. Hypertension 70(4):660–667. https://doi.org/10.1161/HYPERTENSIONAHA.117.07802
Hu Y, Zhang L, Wu X, Hou L, Li Z, Ju J et al (2016) Bisphenol A, an environmental estrogen-like toxic chemical, induces cardiac fibrosis by activating the ERK1/2 pathway. Toxicol Lett 250–251:1–9. https://doi.org/10.1016/j.toxlet.2016.03.008
Husoy T, Andreassen M, Hjertholm H, Carlsen MH, Norberg N, Sprong C et al (2019) The Norwegian biomonitoring study from the EU project EuroMix: levels of phenols and phthalates in 24-hour urine samples and exposure sources from food and personal care products. Environ Int 132:105103. https://doi.org/10.1016/j.envint.2019.105103
Jamal A, Rastkari N, Dehghaniathar R, Nodehi RN, Nasseri S, Kashani H et al (2020) Prenatal urinary concentrations of environmental phenols and birth outcomes in the mother-infant pairs of Tehran Environment and Neurodevelopmental Disorders (TEND) cohort study. Environ Res 184:109331. https://doi.org/10.1016/j.envres.2020.109331
Jedynak P, Tost J, Calafat AM, Bourova-Flin E, Busato F, Forhan A et al (2021) Pregnancy exposure to synthetic phenols and placental DNA methylation - an epigenome-wide association study in male infants from the EDEN cohort. Environ Pollut 290:118024. https://doi.org/10.1016/j.envpol.2021.118024
Kim D, Yoo ER, Li AA, Cholankeril G, Tighe SP, Kim W et al (2019) Elevated urinary bisphenol A levels are associated with non-alcoholic fatty liver disease among adults in the United States. Liver Int 39(7):1335–1342. https://doi.org/10.1111/liv.14110
Lakind JS, Goodman M, Mattison DR (2014) Bisphenol A and indicators of obesity, glucose metabolism/type 2 diabetes and cardiovascular disease: a systematic review of epidemiologic research. Crit Rev Toxicol 44(2):121–150. https://doi.org/10.3109/10408444.2013.860075
Liang Y, Wang X, Dong S, Liu Z, Mu J, Lu C et al (2020) Size distributions of nitrated phenols in winter at a coastal site in north China and the impacts from primary sources and secondary formation. Chemosphere 250:126256. https://doi.org/10.1016/j.chemosphere.2020.126256
Naftolin F, Friedenthal J, Nachtigall R, Nachtigall L (2019) Cardiovascular health and the menopausal woman: the role of estrogen and when to begin and end hormone treatment. F1000Res 8:F1000 Faculty Rev-1576. https://doi.org/10.12688/f1000research.15548.1
Patti MA, Henderson NB, Gajjar P, Eliot M, Jackson-Browne M, Braun JM (2021) Gestational triclosan exposure and infant birth weight: a systematic review and meta-analysis. Environ Int 157:106854. https://doi.org/10.1016/j.envint.2021.106854
Salamanca-Fernandez E, Rodriguez-Barranco M, Petrova D, Larranaga N, Guevara M, Moreno-Iribas C et al (2020) Bisphenol A exposure and risk of ischemic heart disease in the Spanish European Prospective Investigation into cancer and nutrition study. Chemosphere 261:127697. https://doi.org/10.1016/j.chemosphere.2020.127697
Santoro A, Scafuro M, Troisi J, Piegari G, Di Pietro P, Mele E et al (2021) Multi-systemic alterations by chronic exposure to a low dose of bisphenol A in drinking water: effects on inflammation and NAD(+)-dependent deacetylase sirtuin1 in lactating and weaned rats. Int J Mol Sci 22(18):9666. https://doi.org/10.3390/ijms22189666
Shankar A, Teppala S, Sabanayagam C (2012) Bisphenol A and peripheral arterial disease: results from the NHANES. Environ Health Perspect 120(9):1297–1300. https://doi.org/10.1289/ehp.1104114
Taheri E, Riahi R, Rafiei N, Fatehizadeh A, Iqbal HMN, Hosseini SM (2021) Bisphenol A exposure and abnormal glucose tolerance during pregnancy: systematic review and meta-analysis. Environ Sci Pollut Res Int 28(44):62105–62115. https://doi.org/10.1007/s11356-021-16691-4
Tallquist MD, Molkentin JD (2017) Redefining the identity of cardiac fibroblasts. Nat Rev Cardiol 14(8):484–491. https://doi.org/10.1038/nrcardio.2017.57
Wang D, Zhang Y, Li J, Dahlgren RA, Wang X, Huang H et al (2020) Risk assessment of cardiotoxicity to zebrafish (Danio rerio) by environmental exposure to triclosan and its derivatives. Environ Pollut 265(Pt A):114995. https://doi.org/10.1016/j.envpol.2020.114995
Zhang H, Yang R, Shi W, Zhou X, Sun S (2022) The association between bisphenol A exposure and oxidative damage in rats/mice: a systematic review and meta-analysis. Environ Pollut 292(Pt B):118444. https://doi.org/10.1016/j.envpol.2021.118444
Zhang Y, Huang M, Zhuang P, Jiao J, Chen X, Wang J et al (2018) Exposure to acrylamide and the risk of cardiovascular diseases in the National Health and Nutrition Examination Survey 2003–2006. Environ Int 117:154–163. https://doi.org/10.1016/j.envint.2018.04.047
Author information
Authors and Affiliations
Contributions
Wenyu Shi designed the study; **g He wrote the manuscript; and Ziwei Chen performed the statistical analysis. All the authors approved the manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
The protocol was approved by the NCHS Research Ethics Review Board (Protocol #98–12, Protocol #2005–06, and Protocol #2011–17).
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Additional information
Responsible Editor: Lotfi Aleya
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Chen, Z., He, J. & Shi, W. Association between urinary environmental phenols and the prevalence of cardiovascular diseases in US adults. Environ Sci Pollut Res 29, 42947–42954 (2022). https://doi.org/10.1007/s11356-021-18323-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11356-021-18323-3