Effects of Per- and polyfluoroalkyl substances on atherosclerosis: an evidence-based risk assessment in the context of the TRAEC strategy

The TRAEC strategy enables a comprehensive evaluation of epidemiological, in vivo, and in vitro studies by integrating five key components: reliability score, concentration weighting, risk intensity, relevance score, and completeness score. Using scientifically established formulas, the overall validity of the evidence, as well as the direction and strength of the association, are determined. Based on this approach, we evaluated the five screened PFASs: PFOS (5.83), PFOA (5.51), PFHxS (4.59), PFNA (5.19), and PFDA (4.47), all of which were classified as medium-risk compounds. By calculating the average score of these five PFASs to represent the overall risk coefficient for PFASs exposure, we obtained a value of 5.18. This indicates that PFASs exposure poses a moderate risk of influencing AS.