Urinary Bisphenol: A Concentration and Risk of Future Coronary Artery Disease in Apparently Healthy Men and Women.
Circulation. 2012 Feb 21. Epub 2012 Feb 21. PMID: 22354940
1 Peninsula Medical School, University of Exeter, Exeter, United Kingdom;
BACKGROUND: The endocrine disrupting chemical Bisphenol A (BPA) is widely used in food and beverage packaging. Higher urinary BPA concentrations (uBPA) were cross-sectionally associated with heart disease in NHANES 2003/04 and NHANES 2005/6, independent of traditional risk factors. METHODS AND RESULTS: We included 758 incident coronary artery disease (CAD) cases and 861 controls followed for 10.8 yrs from the European Prospective Investigation of Cancer - Norfolk UK. Respondents aged 40-74 yrs and free of CAD, stroke or diabetes provided baseline spot urine samples. uBPA concentrations (median value 1.3 ng/ml) were low. Per standard deviation (4.56ng/ml) increases in uBPA concentration were associated with incident CAD in age, sex and urinary creatinine adjusted models (n=1919, OR=1.13 95% CI 1.02 to 1.24, p=0.017). With CAD risk factor adjustment (including education, occupational social class, BMI category, systolic blood pressure, lipid concentrations and exercise) the estimate was similar but narrowly missed two-sided significance (n=1744 OR=1.11 95% CI: 1.00 to 1.23, p=0.058). Sensitivity analyses with the fully adjusted model, excluding early CAD (<3 year follow up); those with BMI>30; abnormal renal function; or adjusting additionally for vitamin C; C-reactive protein; or alcohol consumption, all produced similar estimates and all showed associations at p≤0.05. CONCLUSIONS: Associations between higher BPA exposure (reflected in higher urinary concentrations) and incident CAD during over ten years of follow-up showed similar trends to previously reported cross-sectional findings in the more highly exposed NHANES respondents. Further work is neededto accurately estimate the prospective exposure response curve and to establish the underlying mechanisms.