Our understanding of the negative health impacts of PFAS is increasing all the time. More research is finding links between PFAS exposure and a variety of health issues. Several organ systems are impacted by high levels of PFAS, including proven links with certain cancers, changes to reproductive health, hormone disruption, and lowered immune function. In this article, we take a look at the links between PFAS exposure and cardiovascular health.
Cardiovascular disease is complex
Before we get into some of the science behind PFAS and cardiovascular disease (CVD), let’s first understand what cardiovascular disease is. CVD is a complex set of diseases that involve the heart or blood vessels. Heart attack is one outcome of CVD that most people are familiar with. Stroke, usually caused by a blood clot in the brain, is another outcome of CVD that is fairly well known. There are other cardiovascular diseases like heart failure (the heart doesn’t pump enough blood), and arrhythmias (irregular heartbeat), to name a few.
The underlying issue in most CVD is called atherosclerosis, or hardening of the arteries. This condition develops over time as plaque builds up in the walls of the arteries. The arteries narrow and thicken, making it more difficult for blood to flow properly.
What makes cardiovascular disease complex is that there are lifestyle, genetic, and environmental factors that contribute to CVD.
Lifestyle factors
So much of our daily habits can contribute to increased risk of CVD. What we eat, drink, and consume throughout our lives has a strong impact on disease outcomes. Unhealthy diets, high alcohol consumption, smoking, and the use of certain recreational drugs can increase the risk of CVD. Lack of physical activity, stress, and poor sleep also contribute to higher rates of CVD. Being overweight is one potential symptom of these lifestyle factors and is associated with increased CVD risk.
Genetic factors
Family history and genetics play an important role in cardiovascular disease. A family history of CVD, especially if close relatives have had heart attacks or strokes at a young age, increases the likelihood that you will also develop CVD. Some of this is due to genes that are inherited. As one example, a condition known as familial hypercholesterolemiaIt causes very high “bad” cholesterol levels.
Environmental factors
The environment as it relates to cardiovascular disease can span a wide range of domains and includes the natural, social, and built environments. For the purposes of this article, we’ll focus on environmental pollutants and their impact on CVD. Some of the key sources of cardiovascular risk in the environment include air pollution, heavy metal exposure, and toxic chemicals. Breathing polluted air, especially PM2.5 (particulate matter under 2.5 microns) and ultra-fine particulate matter, leads to high blood pressure, damage to blood vessels, and chronic inflammation of the circulatory system. Heavy metals like lead, cadmium, arsenic, mercury, and chromium disrupt cell function and signaling that can lead to arrhythmias and altered heart function. Toxic chemicals contained in pesticides and organic solvents, as well as PFAS “forever chemicals,” can also increase the risk of developing CVD.
The link between PFAS exposure and cardiovascular disease
Studies have shown that high levels of PFAS exposure is associated with increased risk of cardiovascular disease. The detailed mechanisms by which PFAS increases CVD risk is still being researched. What is known is that PFAS increases “bad” cholesterol (LDL, triglycerides), and these chemicals also increase inflammation and interact with hormones to contribute to CVD. Below, we take a look at some of the scientific studies that cover these findings.
PFAS increases “bad” cholesterol
We typically think of poor diets loaded with saturated and trans fats as being the main culprits of high cholesterol. And while diet, lifestyle, and genetic factors play a key role, one overlooked area is toxin exposure.
Awareness about constant exposure to toxins and what that’s doing to our health has been gaining steam over the past several decades. Regarding PFAS in particular, dozens of studies have looked at potential links between PFAS exposure and cholesterol levels. In a 2023 meta-analysis led by researchers at Harvard T.H. Chan School of Public Health, a quantitative association was made between PFAS blood levels and cholesterol levels. (A meta analysis combines results from different studies and applies statistical methods to draw conclusions from the combined research data).
In this meta-analysis, data from 29 different studies were combined where each study looked at blood concentrations of five different PFAS compounds (PFOA, PFOS, PFHxS, PFDA, and PFNA) and four blood lipid measures (total cholesterol, HDL-C, LDL-C, and triglycerides) in adults. The important measure that this study looked for was a dose-response relationship. That is, is there a relationship between higher levels of PFAS and high cholesterol?
Out of the 29 studies, PFOA (perfluorooctanoic acid) and PFOS (perfluorooctane sulfonate) were the most commonly studied, covered by 28 and 21 studies, respectively. These studies on PFOA and PFOS represented thousands of subjects with matching cholesterol data and found that high blood concentrations of these two compounds were significantly associated with high triglyceride and LDL-C levels. Results for the other three compounds, PFHxS, PFDA, and PFNA, had some correlations to cholesterol levels but were not as conclusive.
PFOA and PFOS are the main “legacy” PFAS chemicals that have been widely used since the 1950s and take the longest time to clear your body. (See our blog for a short history of PFOA and PFOS).
PFAS may contribute to other risk factors of cardiovascular disease
The role of PFAS exposure and cholesterol is a fairly well-studied topic compared to other impacts of PFAS on CVD. Studies that link PFAS to other risks such as inflammation, hormone disruption, and obesity are somewhat limited.
That said, a review paper published in 2022 does an eloquent job of assessing potential connections between PFAS and inflammation across 321 studies. The authors found that several PFAS chemicals may induce chronic inflammation. This includes changes to inflammatory pathways such as cytokines, macrophages and eosinophils, as well as protein and gene expression biomarkers of inflammation. The scientific details of the findings are beyond the scope of this article, but a simplified interpretation is that constant exposure to PFAS causes immune responses that lead to inflammation.
Hormone disruption and obesity are factors that also play a role in CVD. A congressional briefing sponsored by NIH highlighted the need to further study this topic. Early research indicates a link between greater PFAS exposure and increased risk for obesity, which is a key risk factor in cardiovascular disease. In a randomized dietary trial of 381 participants, researchers found greater weight gain in subjects with higher PFAS levels compared to those with lower PFAS levels. While the study was not measuring obesity, the authors indicated a role of PFAS in contributing to weight gain beyond diet and exercise.
Conclusions
Cardiovascular disease is complex and develops over a long period of time. Different personal, genetic, and environmental factors play a role in development of CVD. Environmental pollutants, including PFAS, could play a role in increasing your risk of developing CVD. Learn more about your PFAS levels using our at-home blood tests and take the first step in reducing your PFAS risk.
Disclaimer: This article is for educational and informational purposes only. Nothing in this article or on the web site represents medical advice or an offer of medical, diagnostic, or treatment products or services. Anyone concerned about their health should consult a licensed medical professional.
