Association of PFAS and Metals with Cardiovascular Disease Risk: Exploring the Mediating Effect of Diet.

PFOA exhibited a marginally significant positive association (β = 1.025, p = 0.095, 95% CI: −0.178, 0.0934).

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Additionally, DII demonstrated a borderline significant positive association with CRP, reinforcing the notion that pro-inflammatory dietary patterns may exacerbate systemic inflammation, potentially amplifying the adverse cardiovascular effects of environmental toxicants [ 26 , 27 ].

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Although most observed associations in our analyses were modest and did not reach statistical significance—evidenced by wide credible intervals consistently overlapping zero—the trends noted align with prior studies suggesting potential biological pathways connecting these pollutants with cardiovascular health outcomes.

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CDEs at Different Quantiles of DII (10%, 50%, 75%): The Controlled Direct Effects show a negative trend, with effects being slightly negative, indicating that exposure effects on SBP are negative in older individuals across PFAS/metal exposure levels.

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The plot shows an increasing trend from negative to slightly positive values across quantiles, but large credible intervals that cross zero emphasize the uncertainty in the results.

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