Effects of perfluoroalkyl chemicals on stroke incidence, mortality and morbidity

慢性病是一个巨大的公共卫生和经济负担， 科学证据支持异生环境化学品（XECs）在发展中的因果作用 和慢性疾病的进展，包括心血管疾病和脑血管疾病（中风）。几类 的XEC，包括持久性有机污染物和重金属，已被确定为增加中风 风险，而且有新的证据表明，另一类XEC，全氟烷基化学品（PFC），也可能 影响中风风险。然而，在理解不同的全氟化学品如何 影响中风风险和中风结果，或如何通过其他条件介导这些健康影响 影响中风风险和严重程度的因素。该项目的三个目标是：1）确定 PFCs与卒中发生率之间的关系; 2）确定PFCs与 中风死亡率和发病率; 3）描述PFCs对中风发病率的自然间接影响， 高胆固醇血症和高血压介导的死亡率和发病率，以及甲状腺和 免疫功能该项目将作为REGARDS研究的辅助研究进行，该研究是NIH资助的 队列研究，已确定入组> 30，000人。拟议工作的贡献 本文将对多种PFC化合物对中风风险和中风的影响进行系统评价。 在一个不同的队列中，具有广泛的PFC暴露的结果。这里提出的研究是创新的 因为：1）将对多种全氟化学品化合物进行评估; 2）一系列与全氟化学品有关的健康影响和后果 3）与PFC相关的自然、间接健康影响和结果将被 4）本研究将建立在一个完善的研究，因此将有效地解决 研究的目的。预计这里提出的研究结果将大大提高 了解PFC如何影响脑血管健康，因此将是一个重要的进展， 一系列研究，预计将为公共卫生战略的制定提供有意义的信息 以及关于全氟化学品安全接触水平的建议。

Chronic diseases are an enormous public health and economic burden, and new and growing lines of scientific evidence support a causal role for xenobiotic environmental chemicals (XECs) in the development and progression of chronic diseases, including cardio- and cerebrovascular disease (stroke). Several classes of XECs, including persistent organic pollutants and heavy metals, have been identified as increasing stroke risk, and there is emerging evidence that another class of XECs, perfluoralkyi chemicals (PFCs), may also influence stroke risk. However, there remains a knowledge gap in understanding how different PFCs may affect stroke risk and stroke outcome or how these health effects may be mediated through other conditions that causally affect stroke risk and severity. The three aims of this project are to: 1) Determine the association between PFCs and the incidence of stroke; 2) Determine the association between PFCs and stroke mortality and morbidity; and 3) Describe the natural Indirect effect of PFCs on stroke incidence and mortality and morbidity, as mediated through hypercholesterolemia and hypertension, and thyroid and immune function. This project will be conducted as an ancillary study within the REGARDS Study, an NIHfunded cohort study with an established enrollment of >30,000 people. The contribution of the work proposed here will be a systematic evaluation of the effect of multiple PFC compounds on stroke risk and stroke outcome in a diverse cohort, with a wide range of PFC exposure. The research proposed here is innovative because: 1) multiple PFC compounds will be evaluated; 2) a range PFC-related health effects and outcomes beyond mortality will be determined; 3) natural, indirect PFC-related health effects and outcomes will be determined; and 4) the present study will build upon a well-established study and so will efficiently address the study aims. It is anticipated that the results from the research proposed here will substantially advance the understanding of how PFCs affect cerebrovascular health and so will be an important progression in a continuum of research that is expected to meaningfully inform the development of public health strategies and recommendations regarding safe levels of exposure to PFCs.