Objective To investigate the association between serum perfluorooctanoic acid (PFOA) concentration and cardiovascular disease, as measured by homocysteine level and blood pressure in a representative sample of US adults.

Methods A cross-sectional study of 2934 adults (≥20 years) who participated in the 2003–2004 and 2005–2006 National Health and Nutrition Examination Survey and had detectable levels of PFOA in their serum. The health effects analysed as potentially associated with PFOA exposure included homocysteine level and blood pressure.

Results The geometric mean value (95% CI) of the study participants' serum PFOA concentration was 4.00 μg/l (95% CI 3.86 to 4.13). The homocysteine and systolic blood pressure were shown to increase significantly with an increase in the log-transformed serum PFOA concentration, after adjusting for potential confounding variables. Adjusted ORs comparing participants at the 80th versus the 20th percentiles were 2.62 for hypertension (95% CI 2.09 to 3.14), and a positive association was also evident in models based on quartiles or based on restricted cubic splines.

Conclusion These findings suggest that background exposure to PFOA may continue a risk factor for the development of cardiovascular diseases.