Serum legacy and emerging PFAS and lipid biomarkers in patients with chronic coronary syndrome: a cross-sectional human biomonitoring study.

Abstract

Per- and polyfluoroalkyl substances (PFAS) have been associated with altered lipid metabolism in general populations, but evidence remains limited among patients with established coronary artery disease, particularly for emerging PFAS replacement compounds. We conducted a cross-sectional study of 155 patients with chronic coronary syndrome from Beijing Anzhen Hospital to examine associations between serum legacy and emerging PFAS and lipid biomarkers. Serum concentrations of 33 PFAS were measured by liquid chromatography-tandem mass spectrometry, and 10 compounds with detection rates >80% were included in the primary analyses. Lipid outcomes included total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), non-HDL cholesterol, remnant cholesterol, and lipoprotein(a). PFAS concentrations were log2-transformed, lipid outcomes were ln-transformed. Associations were estimated using multivariable linear regression, with Benjamini-Hochberg false discovery rate correction applied separately within each lipid outcome-specific family of 10 PFAS tests. In fully adjusted models, each doubling of serum PFOS and 6:2 Cl-PFESA concentrations was associated with higher HDL-C levels after outcome-specific BH-FDR correction within the family of 10 PFAS-HDL-C tests (PFOS: β = 0.040, 95% CI: 0.011 to 0.070, q = 0.038; 6:2 Cl-PFESA: β = 0.048, 95% CI: 0.019 to 0.077, q = 0.012). However, neither association remained statistically significant after BH-FDR correction across all 70 individual PFAS-lipid tests. Effect estimates were similar in robust regression and after excluding influential observations, but were attenuated after excluding the highest 5% of exposure values. These findings should not be interpreted as indicating a favorable lipid effect and require confirmation in larger prospective studies.