PFAS and cardiovascular risk : The effects of exposure to perfluoroalkyl and polyfluoroalkyl substances on cardiovascular health.

Perfluoroalkyl and polyfluoroalkyl substances (PFAS) encompass numerous synthetic (man-made) chemicals with widespread use in industry and consumer products. Universal and life-long human exposure is nearly unavoidable and thus health concerns have emerged over the years, including the development of cardiovascular disease (CVD). Existing evidence on the link between PFAS exposure and CVD is somewhat mixed. The aim of the present narrative review is to summarize the available evidence on the impact of varying levels of exposure to PFAS on traditional CVD risk factors as well as subclinical and overt CVD. While there is mounting evidence of the association between PFAS exposure and dyslipidemia, and PFAS exposure and hypertensive disorders of pregnancy, the evidence on the link between PFAS exposure and other CVD risk factors is less clear. Likewise, evidence on PFAS and overt subclinical and clinical CVD is inconsistent, with studies showing mixed results or even a protective association between PFAS exposure and clinical CVD. Potential mechanisms of disease involve PFAS-induced inflammation, oxidative stress and endothelial dysfunction, impacting CVD risk. Certain populations, including pregnant women, children and individuals with pre-existing conditions, are more vulnerable to PFAS-related health effects. Exposure disparities are evident, with marginalized communities facing higher exposure levels and fewer resources for mitigation. Addressing PFAS exposure requires more assessment of the impact of PFAS mixtures and potential cumulative or interactive effects and additional regulatory actions to reduce emerging PFAS and limit PFAS levels in drinking water. Interdisciplinary research efforts are crucial to fully understand the impact of PFAS and develop effective mitigation strategies.