Relationship between adult’s cardiovascular diseases and ethylene oxide exposure: Based on NHANES 2013~2018

MAO Jin-hua; CHENG Xu; WEI Qiong; ZHANG Dong-mei

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China Environmental Science ›› 2025, Vol. 45 ›› Issue (11) : 6423-6432.

Environmental Toxicology and Environmental Health

Relationship between adult’s cardiovascular diseases and ethylene oxide exposure: Based on NHANES 2013~2018

MAO Jin-hua, CHENG Xu, WEI Qiong, ZHANG Dong-mei

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Abstract

The relationship between ethylene oxide (EO) and cardiovascular disease risk was investigated in this article. A total of 5041 adults were enrolled, and ethylene oxide levels were measured in serum using hemoglobin ethylene oxide conjugate (HbEO) as a biomarker. Data were obtained from the National Health and and Nutrition Examination Survey (NHANES) database in the United States between 2013 and 2018. Weighted logistic regression models and restricted cubic spline plots were used to examine the dose-response relationship between HbEO and cardiovascular disease risk. Subgroup analyses were conducted to evaluate heterogeneity in the study. Through multiple regression analysis, it was found that serum HbEO levels were positively associated with cardiovascular disease risk, and statistical significance was maintained after adjustment for multiple confounders (OR: 1.15, [95% CI: 1.02~1.30], P=0.021). For most cardiovascular diseases, increased exposure to ethylene oxide was associated with elevated OR values, although this increase was not always statistically significant. Additionally, HbEO was positively correlated with the incidence of angina pectoris and heart attack, with the highest OR values observed after full adjustment (OR=1.36 [95% CI: 1.11~1.68] and OR=1.35 [95% CI: 1.14~1.60], respectively). Angina pectoris was the most affected outcome.A significant non-linear relationship was identified between HbEO and overall cardiovascular disease risk (P-overall=0.002, P-non-linear=0.006). Dose-response analysis indicated that elevated serum HbEO levels were associated with an increased risk of angina, with evidence supporting a linear relationship (p-overall=0.012, p-non-linear=0.748). A significant non-linear association was also observed between HbEO and heart attack risk (p-overall<0.001, p-non-linear=0.011).In summary, ethylene oxide metabolites in the blood were associated with an increased incidence of cardiovascular diseases, particularly angina pectoris and heart attack. Further research is needed to confirm these findings.

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cardiovascular disease / ethylene oxide / cross-sectional study / NHANES

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MAO Jin-hua, CHENG Xu, WEI Qiong, ZHANG Dong-mei. Relationship between adult’s cardiovascular diseases and ethylene oxide exposure: Based on NHANES 2013~2018[J]. China Environmental Science. 2025, 45(11): 6423-6432

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