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Ischaemic heart disease mortality study among workers with occupational exposure to ammonium perfluorooctanoate
  1. C J Sakr,
  2. J M Symons,
  3. K H Kreckmann,
  4. R C Leonard
  1. Epidemiology Program, Integrated Health Services, EI du Pont de Nemours and Company, Newark, Delaware, USA
  1. Correspondence to Dr Carine J Sakr, Epidemiology Program, Integrated Health Services, EI du Pont de Nemours and Company, Newark, DE 19714, USA; Carine.J.Sakr{at}


Objectives: Ammonium perfluorooctanoate (APFO) is a biopersistent surfactant used in the manufacture of several types of fluoropolymers. Based on previous findings of increased serum lipid levels associated with exposure to APFO, we evaluated ischaemic heart disease (IHD) mortality in a cohort of occupationally exposed workers.

Methods: Relative risks (RR) were estimated from exposure–response analyses of cumulative exposure measures using proportional hazards regression models.

Results: 239 IHD deaths have occurred in the cohort of 4747 workers with work histories from 1948 through 2002. RR estimates indicate no statistically significant increased mortality risk for IHD associated with estimated cumulative exposure. We observed a positive trend only at an exposure lag of 10 years. This finding was not reproduced in other 5-year exposure lags and was attenuated when different cutpoints for exposure categorisation were used.

Conclusion: This exposure–response study shows no convincing evidence of increased IHD mortality risk for APFO-exposed workers at this plant. Further studies evaluating the incidence of IHD are being conducted.

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  • Funding This work was funded by EI du Pont de Nemours and Company.

  • Competing interests All the authors were employees of EI du Pont de Nemours and Company at the time of the study.

  • Role of the sponsor: The organisation providing sponsorship for the study played no role in the design and conduct of the study, including collection, management, analysis and interpretation of the data. The sponsors did review the manuscript to ensure technical accuracy.

    Author contributions: Study concept and design: RC Leonard, CJ Sakr, JM Symons; Acquisition of data: RC Leonard, KH Kreckmann; Statistical analysis: CJ Sakr, JM Symons; Interpretation of the data: CJ Sakr, JM Symons, KH Kreckmann, RC Leonard; Drafting of the manuscript: CJ Sakr, JM Symons, KH Kreckmann, RC Leonard; Critical revision of the manuscript for important intellectual content: CJ Sakr, JM Symons, KH Kreckmann, RC Leonard; Study supervision: RC Leonard, JM Symons.

  • Provenance and Peer review Not commissioned; externally peer reviewed.