A major study has shed light on the serious health implications of phthalates, chemicals derived from plastics, on cardiovascular health globally. The research indicates that daily exposure to phthalates from commonplace plastic products may be a significant, yet often overlooked, contributor to the rising rates of heart disease, particularly in developing regions.

Published in the journal eBioMedicine, this groundbreaking study offers a comprehensive analysis of phthalate-related cardiovascular mortality across various countries. It aims to quantify the adverse health effects these chemicals have, particularly concerning cardiovascular disease (CVD).

So, what exactly are phthalates? These chemicals, widely used to soften plastics, have been prevalent since the 1960s. Despite a significant 60% decrease in CVD-related deaths due to extensive public health interventions addressing risk factors such as obesity, high blood pressure, unhealthy diets, and smoking, CVD continues to pose a grave health threat. In 2019 alone, over 17 million deaths were attributed to this disease, exacerbated by factors like an aging population, environmental risks, and metabolic disorders.

One of the most concerning phthalates is di-2-ethylhexyphthalate (DEHP), commonly employed in manufacturing flexible polyvinyl chloride (PVC) plastics. Research has established that phthalates act as antiandrogens and oxidative stressors, leading to adverse cardiovascular outcomes. Increased exposure to these chemicals is linked to heightened risks of diabetes, atherosclerosis, weight gain, and ultimately, cardiovascular mortality.

Humans encounter micro- and nano-plastics (MNPs) through various means, and a recent study indicated that MNPs could also absorb phthalates, potentially increasing the risk of severe cardiovascular events, such as strokes and heart attacks.

In light of the devastating effects of plastic pollution, the United Nations Environment Assembly announced in February 2022 its intention to negotiate a legally binding framework to combat plastic pollution. The current study supports these negotiations by using data on phthalate exposure to create a global model that estimates country-specific burdens of CVD mortality associated with DEHP.

The researchers analyzed population data from the World Bank for individuals aged 55 to 64, gathering cardiovascular mortality statistics from the Institute for Health Metrics and Evaluation (IHME). They examined four DEHP metabolites: mono (2-ethyl-5-oxohexyl) phthalate (MEOHP), mono (2-ethylhexyl) phthalate (MEHP), mono (2-ethyl-5-carboxypentyl) phthalate (MECPP), and mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), using a mixed-effects regression model to assess phthalate concentrations over time.

The findings were startling, revealing that a total of 356,238 deaths were directly linked to DEHP exposure, with an overwhelming 98% of these attributed to plastics. Alarmingly, approximately 13.4% of all global CVD deaths in 2018 were associated with the four phthalate metabolites.

Sensitivity analyses showed that the mortality directly attributable to DEHP exposure ranged between 356,238 and 356,602 deaths, highlighting a marked increase in CVD-related fatalities compared to previous years.

Data indicated significant variance in DEHP exposure across different regions, with countries in the Pacific, East Asia, South Asia, and the Middle East bearing a disproportionate burden. For instance, Middle Eastern and South Asian nations showed notably high exposure levels, with mean concentrations of MEHP and MEHHP reaching 19.460 μmol/L and 46.107 μmol/L, respectively. In stark contrast, Europe reported the lowest exposure levels, with MEHP and MEHHP concentrations at 3.243 μmol/L and 18.413 μmol/L, respectively.

Notably, the highest disparities in DEHP exposure were found in Africa and the United States, where some regions recorded MECPP concentrations as high as 65.452 μmol/L.

Overall, the study highlighted that around 73.1% of all global deaths from DEHP exposure occurred in Asia, with South Asia and the Middle East facing the highest mortality rates due to CVD linked to these chemicals. Following these regions, deaths were reported in Latin America, East Asia, the Pacific, Canada, Australia, and Africa.

The conclusions drawn from this extensive study demonstrate that phthalate exposure varies widely among different regions, but it remains a ubiquitous contaminant contributing to CVD mortality worldwide. The highest exposure levels were reported in the Middle East, South Asia, and Africa, while Europe showcased the lowest. Furthermore, low- and middle-income countries were found to experience a greater burden of CV deaths attributable to DEHP compared to their high-income counterparts.

These alarming findings reinforce the urgent need for strengthened regulatory measures and enhanced international collaboration to mitigate the health impacts of phthalates, especially in regions where industrialization and plastic consumption are at their peak.