Abstract: SA-PO0385
Associations of Environmental Per- and Polyfluoroalkyl Substances-Metal Mixtures with Blood Pressure and Cardiovascular Risk Among US Veterans and Civilians
Session Information
- CKM: Clinical - Epidemiology and Outcomes
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Cardiovascular-Kidney-Metabolic Health
- 602 Cardiovascular-Kidney-Metabolic Health: Clinical
Authors
- Mazumder, Hoimonty, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Price, Natalie, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
- Gennings, Chris, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Berryman, Claire E., Louisiana State University Pennington Biomedical Research Center, Baton Rouge, Louisiana, United States
- McDonough, Carrie A., Carnegie Mellon University, Pittsburgh, Pennsylvania, United States
- Sanders, Alison P., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Background
Per- and polyfluoroalkyl substances (PFAS) and toxic metals are widespread environmental toxicants that may adversely affect blood pressure (BP) and cardiovascular health. Veteran populations may be particularly vulnerable due to cumulative occupational and environmental exposures that may contribute to elevated cardiovascular risk. However, the combined effects of PFAS-metal mixtures on BP and cardiovascular disease (CVD) risk among veterans and civilians remain poorly understood.
Methods
We analyzed cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2003–2018. Using weighted quantile sum (WQS) regression, we performed stratified analyses to assess associations of PFAS-metal mixtures with systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP), and CVD risk among veterans and civilians. Of 11,284 eligible participants, 10,486 (1248 veterans and 9238 civilians) were included in the final analysis after excluding observations with missing data. The mixture included blood lead, cadmium, PFOA, PFOS, PFHxS, PFNA, PFDA, PFUnDA, and NMeFOSAA. Models were adjusted for age, sex, BMI, race, and diabetes status.
Results
Among veterans, PFAS-metal mixtures were associated with higher DBP (β: 0.74 mmHg; 95% CI: 0.02, 1.47) and lower PP (β: -0.79 mmHg; 95% CI: -1.50, -0.08). Lead and NMeFOSAA jointly contributed approximately 55% of the overall mixture effect on DBP. No significant associations were observed for SBP or CVD risk among veterans. Among civilians, PFAS-metal mixtures were associated with higher SBP (β: 0.98 ; 95% CI: 0.37, 1.59), DBP (β: 0.63; 95% CI: 0.31, 0.96), PP (β: 1.62 ; 95% CI: 1.16, 2.08), and CVD risk (β: 2.15; 95% CI: 1.43, 2.88). Lead and PFHxS together accounted for 53% of the mixture effect on SBP, while cadmium and PFDA jointly accounted for 68% of the mixture effect on DBP. Additionally, PFHxS and NMeFOSAA together contributed 88% of the overall mixture effect on PP.
Conclusion
Environmental PFAS-metal mixtures were associated with adverse BP among veterans and civilians. Veterans demonstrated higher DBP and lower PP associated with greater mixture exposure, suggesting subclinical vascular alterations driven primarily by lead and NMeFOSAA, a PFOS precursor. These findings highlight importance of biomonitoring, exposure reduction strategies, and cardiovascular risk surveillance, particularly among veterans.