Perfluoroalkyl substances and likelihood of stroke in persons with and without diabetes

The main objective of this study is to evaluate the relationship of perfluoroalkyl substances with stroke and any modifying influence of diabetes.

Data on 3921 adults aged ⩾20 years with and 44,285 without diabetes were drawn from the C8 Health Project. Four perfluoroalkyl substances were investigated: perfluorohexane sulphate, C8 - perfluorooctanoic acid, perfluoroctane sulfonate and perfluorononaoic acid.

There were 238 cases of stroke among those with and 643 among those without diabetes. In analyses controlled for age, sex, race, diabetes duration, body mass index, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, C-reactive protein, kidney function and a history of smoking, a history of stroke was significantly inversely associated with serum perfluorohexane sulphate (odds ratio = 0.75, 0.64-0.88) and perfluoroctane sulfonate (odds ratio = 0.81, 0.70-0.90), but not perfluorooctanoic acid (odds ratio = 1.04, 0.94-1.15) or perfluorononaoic acid (odds ratio = 0.89, 0.70-1.14) among those with diabetes. Perfluoroalkyl substances demonstrated no association with stroke among those without diabetes (p interaction = 0.006 and 0.01 for perfluorohexane sulphate and perfluorooctanoic acid, respectively).

In this large cross-sectional study, serum levels of perfluorohexane sulphate and perfluoroctane sulfonate were inversely associated with stroke among those with diabetes. Although mechanisms and implications for this diabetes-specific inverse relationship need to be further explored, our data suggest that perfluoroalkyl substances do not increase risk of stroke among persons with or without diabetes.