The relationship between serum bisphenol a and atherosclerosis biomarkers in primary care patient with metabolic syndrome

Bisphenol A (BPA) is an endocrine-disrupting chemical widely used in consumer products and has been linked to cardiovascular risk through oxidative stress and lipid metabolism disturbances. Individuals with metabolic syndrome (MetS), who already have underlying metabolic and cardiovascular dysfunction, may be especially vulnerable to these effects. This study aimed to evaluate serum BPA levels and their associations with oxidative stress biomarkers and atherogenic lipoproteins in patients with MetS. A cross-sectional study involving 193 MetS patients was conducted at an institutional primary care clinic in Selangor. Serum BPA levels were quantified via liquid chromatography–mass spectrometry (LC‒MS). The concentrations of oxidative stress biomarkers (oxidized LDL [oxLDL] and isoprostane) and atherogenic lipoproteins (small dense LDL [sdLDL] and lipoprotein(a) [Lp(a)]) were assessed. Correlation analysis was used to examine the relationships between serum BPA and oxidative stress and atherogenic biomarkers. Simple and multiple linear regression analyses were conducted to determine the independent associations between serum BPA levels and each biomarker, adjusting for potential confounders such as age, sex, and metabolic parameters. Among the 193 samples, 79 (41%) had quantifiable BPA levels. The majority (92%) of these concentrations were below the tolerable daily intake (TDI) threshold of 0.5 ng/mL, whereas only 8% exceeded this limit, with concentrations ranging from 0.51 ng/mL to 1.36 ng/mL. No significant correlation was detected between serum BPA concentrations and log-transformed levels of sdLDL, Lp(a), isoprostane, or log-transformed oxLDL. Multiple linear regression analysis further confirmed the lack of association between BPA and these cardiovascular biomarkers. However, log-transformed total cholesterol, triglyceride, HDL, and LDL levels were independently associated with log-transformed sdLDL levels. In addition, log- transformed HDL was significantly positively associated with Lp(a) (β=63.26; 95% CI: 18.49 to 108.03; p = 0.006). Malay ethnicity was inversely associated with isoprostane levels (β=-64.32; 95% CI: -118.67 to -9.96; p = 0.021), whereas female sex was significantly associated with elevated log-transformed oxLDL levels (β=0.17; 95% CI: 0.01 to 0.33; p = 0.040). Serum BPA levels were low and not significantly associated with oxidative stress biomarkers or atherogenic lipoproteins in this MetS cohort. Significant associations were observed with conventional lipid measures, and selected demographic factors underscore the complex interplay of metabolic and genetic influences on cardiovascular risk. Longitudinal studies are warranted to further elucidate the role of BPA in cardiometabolic health.