Urine phthalate concentrations are higher in people with stroke: United States National Health and Nutrition Examination Surveys (NHANES), 2001–2004

Associations between plastic-associated chemicals, such as bisphenol A, and cardiovascular disease have begun to emerge in the current century. However, the relationship between urine phthalates and risk of stroke is unclear. It was aimed to study the relationship between urine phthalate concentrations and risk of stroke in a national population-based cross-sectional study.Data were retrieved from United States National Health and Nutrition Examination Surveys, 2001-2004, including demographics, self-reported medical conditions (stroke status) and urine phthalate concentrations. Analyses involved t-test and logistic regression models.Of 13 phthalate concentrations, the mean values of mono-n-butyl phthalate (2001-2002: 131.27 ± 685.62 and 43.02 ± 117.70, P=0.0001; 2003-2004: 114.36 ± 555.41 and 49.48 ± 153.53, P=0.008) and mono-(3-carboxypropyl) phthalate (2001-2002: 13.60 ± 37.05 and 5.48 ± 10.55, P<0.001; 2003-2004: 10.56 ± 38.37 and 5.94 ± 14.76, P=0.038) concentrations were found significantly higher in people with stroke. It was also observed that low doses of mono-n-butyl phthalate (OR 1.0009, 95%CI 0.999-1.003, P=0.266 in 2001-2002, and OR 1.0010, 95%CI 1.0001-1.0019, P=0.028 in 2003-2004) and mono-(3-carboxypropyl) phthalate (OR 1.03, 95%CI 1.00-1.05, P=0.055 in 2001-2002, and OR 1.004, 95% CI 1.00-1.01 P=0.240 in 2003-2004) were associated with higher risk of stroke after full adjustments.Urine phthalate concentrations are potentially associated with increased risk of stroke, although the causality cannot be established in the current cross-sectional study design. Future longitudinal cohort studies and/or clinical trials are warranted to understand the biological mechanism along the pathway before drawing a firm conclusion on the relationship between phthalates and risk of stroke in humans.