LAUSR

Background and objective During recent years, some persistent organic pollutants (POPs) have been linked to atherosclerosis. One group of POPs, the poly‐ and perfluoroalkyl substances (PFASs) have not been investigated with regard to atherosclerotic plaques. Methods Carotid artery atherosclerosis was assessed by ultrasound in 1016 subjects aged 70 years in the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Eight PFASs were detected in >75% of participants' plasma by ultra‐performance liquid chromatography coupled to tandem mass spectrometry (UPLC‐MS/MS). Results No significant linear associations were observed between the PFASs and intima‐media thickness (IMT), or the echogenicity in the intima‐media complex (IM‐GSM, a marker of lipid infiltration in the artery) when men and women were analyzed together. Neither was occurrence of carotid plaques related to PFASs levels. However, highly significant interactions were observed between some PFASs and sex regarding both IM‐GSM and plaque prevalence. Perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluoroundecanoic acid (PFUnDA), were all related to IM‐GSM in a positive fashion in women (p=0.002–0.003), while these relationships were negative in men. The levels of PFUnDA were significantly related to carotid plaque in women (OR 1.59, 95%CI 1.03–2.43, p=0.03), but not in men (OR 0.93, 95%CI 0.62–1.42, p=0.75). Conclusions In this cross‐sectional study, a pronounced gender difference was observed regarding associations between some PFASs, especially the long‐chain PFUnDA, and markers of atherosclerosis, with more pronounced relationships found in women. These findings suggest a sex‐specific role for PFASs in atherosclerosis. HighlightsWe investigated associations between poly‐ and perfluoroalkyl substances (PFASs) levels and atherosclerosis.The levels of PFUnDA were significantly related to carotid plaque in women, but not in men.PFASs levels were no related to carotid artery IMT.The levels of PFUnDA were positively related to echogenicity in women, but inversely in men.