The Adverse Impact of Bisphenol A Exposure on Optimal Cardiovascular Health as Measured by Life's Essential 8 in U.S. Adults: Evidence from NHANES 2005 to 2016

Abstract

Background/Objectives: Cardiovascular diseases are the primary cause of global morbidity and mortality, with cardiovascular health (CVH) remaining well below the ideal level and showing minimal improvement in the U.S. population over recent years. Bisphenol A (BPA), a pervasive environmental contaminant, has emerged as a potential contributor to adverse cardiovascular outcomes. This cross-sectional study delves into the impact of BPA exposure on achieving optimal CVH, as assessed by the Life's Essential 8 metric, among U.S. adults. Methods: Analyzing data from 6635 participants in the National Health and Nutrition Examination Survey (NHANES) collected between 2005 and 2016, BPA exposure was quantified through urinary BPA levels, while optimal CVH was defined using the American Heart Association's Life's Essential 8 criteria, scoring between 80 and 100. Multivariable logistic regression and propensity score matching were employed to evaluate the association between BPA exposure and CVH. Results: This study reveals that individuals in the highest tertile of urinary BPA levels were 27% less likely to attain optimal CVH compared with those in the lowest tertile (OR, 0.73; 95% CI: 0.59-0.92). This negative association persisted across diverse demographics, including age, sex, and race, mirrored in the link between urinary BPA levels and health factor scores. Conclusions: The findings underscore the potential benefits of reducing BPA exposure in enhancing the prevalence of optimal CVH and mitigating the burden of cardiovascular disease. Given the widespread use of BPA, ongoing monitoring of BPA's impact on CVH is essential. Further studies are necessary to elucidate the long-term and causative connections between BPA and CVH. These insights contribute to understanding the complex interplay between environmental factors and CVH outcomes, informing targeted interventions to mitigate cardiovascular disease risk within the population.

Keywords: Life’s Essential 8; NHANES; bisphenol A; cardiovascular disease; cardiovascular health; environmental exposure.

Figure 1

Flow chart of participant selection. Abbreviations: NHANES, National Health and Nutrition Examination Survey; BPA, bisphenol A; LE8, Life’s Essential 8; eGFR, estimated glomerular filtration rate.

Figure 2

Age-adjusted prevalence of optimal CVH in different urinary BPA levels. Age was adjusted by the direct method to the year 2000 Census population projections using the age groups 20–39, 40–59, and 60+. Numbers at the top of the bars represent the weighted percentage. Bar whiskers represent the 95% confidence level. Abbreviations: LE8, Life’s Essential 8; BPA, bisphenol A.

Figure 3

Association of urinary BPA levels with optimal CVH. No covariate was adjusted in crude model. Adjusted covariates in Model 1 included age, sex, race or ethnicity, and urinary creatinine levels. Adjusted covariates in Model 2 encompass those in Model 1, along with marital status, educational level, alcohol consumption, family income-to-poverty ratio, sedentary time, and estimated glomerular filtration rate. The character classification of BPA tertiles was transformed into integers and incorporated into the models to examine the linear trend. Abbreviations: LE8, Life’s Essential 8; OR, odds ratio; CI, confidence interval.

Figure 4

Subgroup analysis of association of urinary BPA levels with optimal CVH. Adjusted covariates included age, sex, race or ethnicity, urinary creatinine levels, marital status, educational level, alcohol consumption, family income-to-poverty ratio, sedentary time, and estimated glomerular filtration rate. Abbreviations: BPA, bisphenol A; OR, odds ratio; CI, confidence interval.

Figure 5

Distribution of propensity score (A) and variables standardized mean difference (B) before and after matching. Matching for age, sex, race/ethnicity, educational level, marital status, FITPR, alcohol consumption, sedentary time, urinary creatinine levels, and eGFR with caliper = 0.05. Abbreviations: FITPR, family income-to-poverty ratio; eGFR, estimated glomerular filtration rate.