Co-Exposure to Bisphenols, Parabens, and Antimicrobials and Association with Coronary Heart Disease: Oxidative Stress as a Potential Mediating Factor?

Coronary heart disease (CHD) is the leading cause of global morbidity, but the effect of plasticizers and antimicrobial additives on CHD is unknown. Here, we conducted a case-control study to investigate the mediating role of oxidative stress in the association between co-exposure to seven bisphenols, four parabens, triclosan (TCS), triclocarban, and CHD risk in Guangzhou, China. Quantile-based g-computation and weighted quantile sum regression were used to analyze mixture-outcome associations. Quantile-based g-computation showed a positive joint effect of a decile increase in exposure to all examined pollutants on CHD risk (OR: 1.52, 95% CI: 1.25-1.84), with bisphenol A (BPA), bisphenol F (BPF), n-butyl paraben (BuP), and TCS representing major contributors. The results also showed a decile nonmonotonic increase in the exposure mixtures, positively correlated with a 2.22 ng/mL (95% CI: 1.21-3.23 ng/mL) elevation of 8-hydroxy-2'-deoxyguanosine (8-OHdG), with BuP, TCS, bisphenol AP (BPAP), and BPF contributing dominantly. Mediation analysis showed that 8-OHdG mediated the relationship between BPA, BPF, BPAP, and TCS, and CHD risk. Moreover, the mediating role of high-density lipoprotein (HDL) between several bisphenols and CHD was also identified. It is yet to be verified, but bisphenols may elevate CHD risk by reducing HDL status and increasing oxidative stress.