Exposure to Phthalates and Cardiovascular Diseases with type 2 Diabetes

Purpose Cardiovascular disease (CVD) results in more than half of the mortality and the majority of morbidity in patients with type 2 diabetes. We aim to evaluate the associations of urinary concentrations of phthalate metabolites with CVD in diabetic patients and explore whether CVD risk factors mediate or interact with these associations.Methods A total of 675 type 2 diabetic participants were enrolled from one community in Shanghai, China in 2018. CVD was defined as a self-reported diagnosis by a physician and included coronary heart disease, myocardial infarction or stroke; it was further reconfirmed in the records from the registration platform. Ten phthalate metabolites were measured in urine.Results Positive associations were found among the level of monoethyl phthalate and monoisobutyl phthalate and CVD (OR 1.138, 95% CI 1.032, 1.254; OR 1.369, 95% CI 1.049, 1.786, respectively). Monoisobutyl phthalate and monobenzyl phthalate were marginally and positively associated with carotid intima-media thickness and common carotid artery diameter, respectively. None of the CVD risk factors, including HOMA-IR, body mass index, lipid profile or blood pressure, significantly mediated the association between the metabolites and CVD. The conditional indirect effect on CVD was significantly stronger for current smoking and dyslipidemia for monoethyl phthalate and for no statin usage and men for monoisobutyl phthalate.Conclusion Phthalate exposure was positively associated with CVD in type 2 diabetes. Type 2 diabetic men who are currently smoking, have an uncontrolled lipid profile and are not using statins may be more susceptible to CVD when exposed to phthalates.