Table 5.

Summaries of the disruptive effects of BPA in human epidemiological studies ¹.

Topic	Studied Population	Gender	Concentration	Observed Effects	References
Cardiovascular diseases	NHANES from 2003–2004 1455 adults aged 18 through 74 years	694 men 761 women	4.53 ng/mL (urinary) 4.66 ng/mL (urinary)	▪Association between CVDs and elevated urinary BPA levels ▪Association between higher BPA concentrations and diabetes	[103]
	NHANES 2003–2006 data, separately between 2003/2004 and 2005/2006 and pooled n = 1455 (2003/04) and n = 1493 (2005/06) adults aged 18–74 years	694 men and 761 women in 2003/04 720 men and 773 women in 2005/06	2.49 ng/mL (urinary) 1.79 ng/mL (urinary)	▪Urinary BPA concentrations were smaller for the 2005/2006 data than those from 2003/3004 ▪Association between higher BPA levels (2003/3004 data) and CAD, but not with diabetes. ▪Data pooled showed an association between higher BPA concentrations and CAD and diabetes	[108]
	Population-based Prospective Investigation of the Vasculature in Uppsala Seniors study (1016 subjects all aged 70)	510 women and 506 men	3.76 ng/mL (serum)	▪Elevated levels of BPA were related to the echogenicity of the plaques, suggesting a role for BPA in atherosclerosis	[105]
	758 incident CAD cases and 861 controls followed for 10.8 years from the European Prospective Investigation of Cancer—Norfolk, UK	534 men and 327 women in control group 501 men and 257 women in CAD group	Control vs. CAD group (1.24 ng/mL vs. 1.35 ng/mL) (urinary)	▪Urinary BPA concentrations were low ▪Increased BPA concentration was associated with incident CAD	[106]
	591 patients participating in The Metabonomics and Genomics in Coronary Artery Disease study in Cambridgeshire, UK	120 controls (62 women and 58 men) 385 patients (301 men and 84 women) 86 Intermediate diseases (43 men and 43 women)	Control vs. CAD vs. intermediate (2.13 vs. 3.82 vs. 3.31 ng/mL) (urinary)	▪Association between BPA exposure with grades of severity of CAD on angiography ▪Higher urinary concentration of BPA in patients with severe CAD compared to patients with normal coronary arteries	[107]
	745 participants in the NHANES 2003–2004	361 women and 392 men	2.30 ng/mL (urinary)	▪A positive association between increased levels of BPA with DBP	[110]
	88 DCM patients and 88 age-and gender-matched healthy controls	59 men and 29 women with DCM 55 men and 33 women Control	DCM vs. control group (6.9 ± 2.7 vs. 3.8 ± 1.9 ng/mL) (serum)	▪Higher levels of BPA in DCM patients compared with the healthy group	[109]
	NHANES 2003–2014 (n = 9139, aged ≥20 years)	4467 men and 4672 women	-	▪Positive association with heart failure, CAD, angina pectoris, MI, and CVDs, which was more evident in males	[104]
Hypertension	1380 subjects from NHANES 2003–2004	700 women and 680 men (580 with hypertension)	1.5–4.0 ng/mL (urinary)	▪A positive association between elevated urinary BPA levels and hypertension	[112]
	560 noninstitutionalized elderly citizens from August 2008 to August 2010 in Seoul from Korean Elderly Environmental Panel Study	521 participants were included (138 men and 383 women)	(men) and 1.3 (women) μg/g of creatinine (urinary)	▪Urinary BPA was associated negatively with HRV and positively with BP ▪BPA was associated with hypertension	[113]
	60 noninstitutionalized elderly participants, who were aged ≥60 years between February 2014 and March 2014	60 participants, 56 were women and 4 male	1.13 ± 1.76 μg/L (urinary)	▪Association between exposure to BPA with BP increased, but differences in HRV were not found	[114]
	A subsample of 2558 randomly selected from the Thai National Health Examination Survey IV, 2009	1275 men and 1283 women	0.35 ng/mL (men) and 0.33 ng/mL (women) (serum)	▪Association between serum BPA levels with hypertension in women	[115]
Pregnancy exposure	645 children at the age of 4 who were born from women who participated, midterm during their pregnancy, in a birth cohort study from August 2008 to July 2011	486 mother–child pairs were included in the present analysis	Maternal urinary: 0.9 μg/L (urinary)	▪A positive association between diastolic (and not systolic) BP of the children with the maternal urinary concentration of BPA	[121]
	152 female volunteer participants in the Human Early-Life Exposome project	152 pregnant women	3.1 μg/g creatinine (urinary)	▪BPA exposure was associated with a significant decrease in systolic and/or diastolic BP	[120]
	1064 mother-child pairs/childhood at a mean age of 9.7 years old	1064 mother-child pais	6.0 nmol/L (boys) and 7.2 nmol/L (girls) (urinary)	▪Higher BP in boys after fetal BPA exposure	[122]
	58 pregnancies, including 35 normotensive and 23 preeclamptic women	35 normotensive pregnant women and 23 preeclamptic pregnant women	Control vs. PE (3.00 vs. 2.80 ng/mL–maternal serum; 2.17 vs. 2.23 ng/mL–fetal serum; 3.00 vs. 9.40–placental homogenate)	▪Placentas from women with PE had a higher accumulation of this EDC compared to placentas from normotensive women	[124]
	A nested case-control population consisting of 130 mothers who delivered preterm and 352 who delivered term from a prospective birth cohort	130 women and 352 controls	7.08% change (adjusted with soluble fms-like tyrosine kinase-1) (urinary)	▪Association between urinary BPA concentrations and angiogenic biomarkers during pregnancy	[125]
	A nested case-control study of preterm birth was performed in 2011 from women enrolled in a prospective birth cohort study at Women’s Hospitals in Brigham and in Boston (included 50 cases of PE)	482 women (50 with PE)	Cases vs. control (1.56 vs. 1.38 ng/mL) (urinary)	▪Early pregnancy (~10 weeks gestation) was a window of increased susceptibility for the development of this HDP associated with BPA exposure	[126]
	1233 women excluding those without any BP measurement or with pre-existing hypertension	1233 women	1.65 ng/mL (urinary)	▪Association of bisphenols in early pregnancy with a risk of PE	[127]
	1 year postpartum among 199 women in Mexico City	199 women	1.18 ng/mL (urinary)	▪Prenatal exposure to BPA was inversely associated with weight at delivery, but there exists a slower rate of weight loss through the first postpartum year	[129]

¹ Legend: BP—blood pressure; BPA—bisphenol A; CAD—coronary artery disease; CVDs—cardiovascular diseases; DCM—dilated cardiomyopathy; EDC—endocrine-disrupting compound; HRV—heart rate variability; MI—myocardial infarction; NHANES—National Health and Nutrition Examination Survey; PE—preeclampsia.