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Exposure to textile fiber dusts, like particulate air pollution, may be associated with cardiovascular disease (CVD) mortality. Bacterial endotoxin, a potent inflammagen found in cotton dust, may be a specific risk factor.Female textile workers (N = 267,400) in Shanghai, China were followed for CVD mortality (1989–2000). Factory exposures were approximated by sector classifications based on materials and processes. Quantitative endotoxin and cotton dust measures were available for a subcohort (n = 3,188). Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence interval (CI).Slightly elevated mortality risk for the cotton sector was seen for ischemic stroke (HR = 1.12, 95% CI: 0.97–1.31) and hemorrhagic stroke (HR = 1.12, 95% CI: 1.02–1.23). Similar hemorrhagic stroke mortality risk was observed in high dust sectors (HR = 1.12, 95% CI: 1.02–1.24). No association was observed for ischemic heart disease.Exposures in textile factories may have contributed to CVD mortality among this cohort. The specific components of these exposures that may be harmful are not clear and should be further investigated. Am. J. Ind. Med. 55:991–999, 2012. © 2012 Wiley Periodicals, Inc.