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5188935 
Journal Article 
Changes in plasma levels of perfluoroalkyl substances (PFASs) are related to increase in carotid intima-media thickness over 10 years - a longitudinal study 
Lind, PM; Salihovic, S; Stubleski, J; Kärrman, A; Lind, L 
2018 
Environmental Health
EISSN: 1476-069X 
BioMed Central 
17 
59 
English 
BACKGROUND: It has previously been reported that the environmental contaminants perfluoroalkyl substances (PFASs) are linked to atherosclerosis in cross-sectional studies. Since cross-sectional studies could be subject to reverse causation, the purpose of this study was to analyze if the longitudinal changes in PFASs during a 10-year follow-up were related to the change in carotid artery intima-media thickness (IMT, ultrasound) during the same period.

METHODS: In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, 1016 individuals were investigated at age 70; 826 of them were reinvestigated at age 75 and 602 at age 80 years. Eight different PFASs were measured in plasma by ultra-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS), and IMT was measured at all three time points. Random-effects mixed regression models were used to examine the associations over time.

RESULTS: IMT increased 0.058 mm during the 10-year period (p < 0.0001). Following adjustment for baseline values of PFASs (age 70) and sex, the changes in plasma levels of 6 of the 8 measured PFASs were significantly related to the change in IMT over the 10-year follow-up period in a positive fashion (p < 0.0062 using Bonferroni correction for 8 tests). Further adjustment for traditional cardiovascular (CV) risk factors (HDL and LDL cholesterol, smoking, systolic blood pressure, statin use, fasting glucose and serum triglycerides) affected these relationships only marginally.

CONCLUSION: The change in plasma levels of several PFASs during 10 years was positively related to increase in IMT seen during the same period, giving prospective evidence that PFASs might interfere with the atherosclerotic process. 
Carotid arteries; Mass spectrometry; Software; Acids; Stroke; Family medical history; Perfluoroalkyls; Age; Heart attacks; Studies; Plasma levels; Health risk assessment; Cholesterol; Cardiovascular disease; Veins & arteries; Scientific imaging; Methods; Older people; Chromatography; Automation; Fasting; Atherosclerosis; Ultrasonic imaging; Correlation analysis 
PFAS
• Additional PFAS (formerly XAgency)
     Literature Search November 2019
          Other Sources
               TEDX
     Screened Studies
          Included
               Include (TIAB)
          Excluded
               Exclude (Full Text)
• Expanded PFAS SEM (formerly PFAS 430)
     Litsearch: September 2019
          Other Sources
               PFAS TOX Database
     Screened Studies
          Included
               Include (TIAB)
          Excluded
               Exclude (Full Text)
• PFAS 150
     Literature Search August 2019
          Other sources
               Reference list review of included studies
               PFAS TOX Database
• PFDA
     June 2022 Pelch Database
     Submitted to EPA
     Literature Searches (through April 2023 update and post-public comment/peer review)a    
          Other
               Published PFAS SEMs
          Title & Abstract Screening
               Tagged as Supplemental
                    Full Text Screening
                         Studies Meeting PECO
                              Human health effects studies
• PFHxS
     Database searches
          Pelch PFAS SEM
     Excluded
          TiAb
     Literature Search Update April 2023
          Included Met PECO
• PFNA
     Literature Search
          Toxline
     PFNA May 2019 Update
          Toxnet
     Title and Abstract Screening
          Full Text Screening
               Studies Meeting PECO
                    Human health effects studies
     June 2022 Pelch Database