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Environ Sci Technol. 2019 Aug 20;53(16):9876-9883. doi: 10.1021/acs.est.9b02963. Epub 2019 Jul 31.

Bisphenol A, Chlorinated Derivatives of Bisphenol A and Occurrence of Myocardial Infarction in Patients with Type 2 Diabetes: Nested Case-Control Studies in Two European Cohorts.

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CHU Poitiers , Department of Public Health , F-86021 Poitiers , France.
Université de Poitiers , School of Medicine and Pharmacy of Poitiers , F-86073 Poitiers , France.
INSERM CIC 1402 , CHU Poitiers , F-86021 Poitiers , France.
Division of Clinical Epidemiology and Aging Research, Division of Preventive Oncology , German Cancer Research Center (DKFZ) , D-69120 Heidelberg , Germany.
Network Aging Research , D-69115 Heidelberg , Germany.
CHU Poitiers , Department of Toxicology and Pharmacokinetics , F-86021 Poitiers , France.
CHU Poitiers , Department of Pharmacy , F-86021 Poitiers , France.
CHU Poitiers , Department of Endocrinology , F-86021 Poitiers , France.
L'institut du thorax, INSERM, CNRS , Univ Nantes, CHU Nantes , F-44093 Nantes , France.


A positive association between Bisphenol A (BPA) exposure and coronary heart disease has been shown, but not in patients with type 2 diabetes (T2D). During the treatment of drinking water, chlorination leads to the formation of chlorinated derivatives of Bisphenol A (ClxBPA), that have higher estrogenic activity than BPA. No evidence exists for a relationship between exposure to ClxBPA and myocardial infarction in patients with T2D. The objective of this study was to evaluate the relationship between exposure to BPA, ClxBPA and the occurrence of myocardial infarction (MI) in patients with T2D. Two nested case-control studies in two independent European cohorts were performed. Each case with incident MI during follow-up was matched to one control on age, sex, and personal cardiovascular history in the same cohort. Association between baseline urine concentrations of BPA and of ClxBPA and incident MI was determined. Exposure to BPA was 31% in the ESTHER cohort and 18% in the SURDIAGENE cohort. In a meta-analysis of the two studies, occurrence of MI was significantly associated with urine BPA detection: adjusted OR = 1.97 (1.05-3.70), p = 0.04. Exposure to ClxBPA significantly differed in the SURDIAGENE and ESTHER studies: 24% and 8%, respectively (p = 0.0003). It was very strongly associated with MI in the SURDIAGENE cohort with an adjusted odds ratio (OR) of 14.15 (2.77-72.40) but this association was not replicated in the ESTHER study: adjusted OR: 0.17 (0.02-1.23). Whether these results may be explained by different water chlorination processes in France and Germany, resulting in different ClxBPA exposure levels, requires further investigation.

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