Abstract
This research explored the effects of 2-hydroxyfluorene exposure on the incidence of cardiovascular diseases (CVDs), particularly examining the mediating role of the lipid accumulation product (LAP) index. Utilizing data from the National Health and Nutrition Examination Survey spanning 2005 to 2018, this analysis evaluated the impact of 2-hydroxyfluorene on CVDs prevalence employing a variety of statistical methods. Logistic regression was applied to investigate relationships within polycyclic aromatic hydrocarbon mixtures, complemented by Bayesian Kernel Machine Regression. Additionally, a mediation analysis explored the influence of the LAP index in moderating the effects of 2-hydroxyfluorene on CVDs prevalence. The research also detailed the link between 2-hydroxyfluorene exposure and specific CVDs such as congestive heart failure, myocardial infarction, angina pectoris, and coronary heart disease, including their mediated impacts. Involving 3653 participants, the study detected a robust positive correlation between 2-hydroxyfluorene exposure and overall CVD risk (OR [95%CI] = 393.5173 [23.6978-6534.5979], P < .0001). This association extended to the prevalence of specific types of CVDs. The LAP index served as a mediator in the connection between 2-hydroxyfluorene exposure and the prevalence of total CVD, congestive heart failure, myocardial infarction, coronary heart disease, and stroke, with mediation percentages of 12%, 10%, 100%, 5%, and 9%, respectively. These results underscore a significant link between 2-hydroxyfluorene exposure and increased prevalence of CVDs, with the LAP index playing a crucial mediating role.