Ethylene Oxide Exposure and the Risk of Congestive Heart Failure: Evidence from NHANES 2013-2018 Data

Background Ethylene oxide (EO), a pervasive industrial chemical, has been linked to carcinogenic and respiratory effects, but its cardiovascular implications remain underexplored. This study investigates the association between EO exposure and congestive heart failure (CHF) using NHANES 2013–2018 data. Methods A cross-sectional analysis of 2,058 participants assessed EO exposure via hemoglobin adducts (HbEO). Multivariable logistic regression models adjusted for sociodemographic, lifestyle, and clinical covariates were used to evaluate CHF risk across HbEO quartiles. Sensitivity analyses addressed potential selection bias from missing data. Results Participants in the highest quartile of HbEO levels exhibited a significantly increased risk of CHF compared to those in the lowest quartile (Odds Ratio = 4.43; 95% CI: 1.41–13.98; P = 0.011), with a dose-response trend evident (P for trend = 0.042). Subgroup analyses further showed consistent associations across demographics and health status, with gender differences observed in the relationship between log10-HbEO and CHF (P for interaction < 0.0491) and renal failure modifying the relationship between log10-HbEO and CHF (P for interaction < 0.0146). Conclusion HbEO levels are robustly associated with CHF risk, emphasizing the need for stricter EO exposure regulations and targeted screening in high-risk populations.