Heart disease deaths worldwide linked to chemical widely used in plastics (Apr 2025) Phthalate exposure from plastics and cardiovascular disease: global estimates of attributable mortality and years life lost Study

[Michael Harrop]

https://medicalxpress.com/news/2025-04-heart-disease-deaths-worldwide-linked.html
https://www.thelancet.com/journals/ebiom/article/PIIS2352-3964(25)00174-4/fulltext

"Our results underscore the urgent need for global regulations to reduce exposure to these toxins, especially in areas most affected by rapid industrialization and plastic consumption,"

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Summary​

Background​

New evidence has emerged that plastic polymers and their chemical additives, particularly di-2-ethylhexylphthalate (DEHP), contribute to cardiovascular disease (CVD). Phthalates are commonly used in the production of plastic materials and have been linked to increased oxidative stress, metabolic dysfunction, and cardiovascular disease. Estimates of phthalate-attributable cardiovascular mortality have been made for the US, but global estimates are needed to inform ongoing negotiations of a Global Plastics Treaty.

Methods​

Cardiovascular mortality data from the Institute for Health Metrics and Evaluation (IHME) and regional DEHP exposure estimates from several sources were used to estimate burden. Hazard ratios of CV mortality were calculated using published exposure estimates, and country-level cardiovascular mortality rates were used to calculate excess deaths and years of life lost (YLL) due to DEHP exposure.

Findings​

In 2018, an estimated 356,238 deaths globally were attributed to DEHP exposure, representing 13.497% of all cardiovascular deaths among individuals aged 55–64. Of these, 349,113 were attributed to the use of plastics. Geographic disparities were evident, with South Asia and the Middle East suffering the greatest percentage of cardiovascular deaths attributable to DEHP exposure (16.807%). The Middle East, South Asia, East Asia, and the Pacific accounted for the largest shares of DEHP-attributable CVD deaths (73.163%). Globally, DEHP resulted in 10.473 million YLL.

Interpretation​

Plastics pose a significant risk to increased cardiovascular mortality, disproportionately impacting regions which have developing plastic production sectors. The findings underscore the need for urgent global and local regulatory interventions to kerb mortality from DEHP exposure.

Funding​

Bloomberg Philanthropies and the National Institutes of Health.

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A CNN article covers a previous, related study:

Previous research by Trasande and his team measured the urine concentration of phthalates in more than 5,000 adults in the United States and compared those levels with the risk of early death over an average of 10 years.

In that study, the researchers found phthalates may contribute to some 91,000 to 107,000 premature deaths a year among Americans ages 55 to 64. People with the highest levels of phthalates had a greater risk of death from any cause, especially cardiovascular mortality, according to the study.

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Phthalates and attributable mortality: A population-based longitudinal cohort study and cost analysis (2021) https://www.sciencedirect.com/science/article/abs/pii/S0269749121016031

Highlights​

• Phthalate exposures were associated with all-cause and cardiovascular mortality.
• Further studies are needed to corroborate observations and identify mechanisms.
• Extrapolating to 55–64 year olds, we identified >90,000 attributable deaths/year.
• The results suggest $39.9–47.1 billion in lost economic productivity/year.
• Regulatory action is urgently needed.

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Abstract​

Context​

Accelerating evidence of endocrine-related morbidity has raised alarm about the ubiquitous use of phthalates in the human environment, but studies have not directly evaluated mortality in relation to these exposures.

Objectives​

To evaluate associations of phthalate exposure with mortality, and quantify attributable mortality and lost economic productivity in 2013–4 among 55–64 year olds.

Design​

This nationally representative cohort study included 5303 adults aged 20 years or older who participated in the US National Health and Nutrition Examination Survey 2001–2010 and provided urine samples for phthalate metabolite measurements. Participants were linked to mortality data from survey date through December 31, 2015. Data analyses were conducted in July 2020.

Main Outcome Measures​

Mortality from all causes, cardiovascular disease, and cancer.

Results​

Multivariable models identified increased mortality in relation to high-molecular weight (HMW) phthalate metabolites, especially those of di-2-ethylhexylphthalate (DEHP). Hazard ratios (HR) for continuous HMW and DEHP metabolites were 1.14 (95% CI 1.06–1.23) and 1.10 (95% CI 1.03–1.19), respectively, with consistently higher mortality in the third tertile (1.48, 95% CI 1.19–1.86; and 1.42, 95% CI 1.13–1.78). Cardiovascular mortality was significantly increased in relation to a prominent DEHP metabolite, mono-(2-ethyl-5-oxohexyl)phthalate. Extrapolating to the population of 55–64 year old Americans, we identified 90,761–107,283 attributable deaths and $39.9–47.1 billion in lost economic productivity.

Conclusions​

In a nationally representative sample, phthalate exposures were associated with all-cause and cardiovascular mortality, with societal costs approximating $39 billion/year or more. While further studies are needed to corroborate observations and identify mechanisms, regulatory action is urgently needed.

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