To the Editor We read the article by Bao et al1 with interest. In this study, single spot urine samples from participants in the NHANES survey, collected between 1999 and 2002, were analyzed for pyrethroid metabolites, including 3-phenoxybenzoic acid (3-PBA). Of the 246 participants who died over the next 14 years, 18 of 41 who died of cardiovascular disease had 3-PBA levels measured in the highest tertile (median [range] urinary PBA level, 1.00 [0.50-69.07] ng/mL). For perspective, a higher single trace concentration of this metabolite in urine was associated with an increase in cardiovascular death in 18 of 41 people over the next 14 years, and an additional 90 of 246 people were at increased risk of all-cause mortality.1
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Dunn (Halcomb) SE, Cole M, Sheets L. Exposure to Pyrethroids and Health Risk. JAMA Intern Med. 2020;180(7):1028. doi:10.1001/jamainternmed.2020.1519
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