A groundbreaking global study led by researchers at NYU Langone Health has shed new light on the staggering health consequences linked to exposure to phthalates, a group of chemicals widely used to soften plastics in household items. The analysis estimates that exposure to di-2-ethylhexyl phthalate (DEHP), a prevalent phthalate, was responsible for over 356,000 deaths from heart disease worldwide in 2018 alone. This revelation uncovers a critical public health concern, revealing that a significant fraction of cardiovascular mortality may be influenced by environmental chemical exposure often overlooked in cardiovascular risk assessments.
Phthalates, ubiquitous in products ranging from cosmetics and detergents to plastic food containers and medical devices, have long been suspected of contributing to multiple health problems. However, their specific role in cardiovascular disease mortality had not been quantitatively estimated on a global scale until now. DEHP, in particular, is a chemical additive used to improve the flexibility of plastic goods, making it a major source of human exposure through ingestion and inhalation. This study’s quantitative linkage between DEHP exposure and cardiovascular deaths marks a pivotal advancement in environmental health research.
The research team utilized extensive health and environmental datasets, incorporating urine biomonitoring samples from population surveys across over 200 countries and territories. These samples reveal internal doses of DEHP metabolites, serving as biomarkers of individual exposure levels. By combining these data with cardiovascular mortality records from the Institute for Health Metrics and Evaluation, the researchers established a robust statistical association between DEHP burden and deaths due to heart disease within the 55 to 64 age demographic. Their findings underscore that more than 13% of heart disease mortality in this age group could be attributed to DEHP exposure.
One of the most striking insights from this analysis is the marked geographical disparity in the burden of DEHP-associated heart disease mortality. The Middle East, South Asia, East Asia, and the Pacific regions collectively accounted for approximately 75% of the global deaths linked to DEHP. This disproportionate impact reflects differences in both exposure levels and regulatory environments. Countries such as India, China, and Indonesia demonstrated the highest death counts, with India alone reporting over 100,000 attributable deaths in 2018. Such findings suggest that rapid industrial growth, insufficient regulatory frameworks, and increased plastic production contribute substantially to the cardiovascular health risks faced by populations in these regions.
Mechanistically, DEHP exposure is believed to exacerbate cardiovascular risk through its pro-inflammatory effects on the vascular system. Previous experimental studies have demonstrated that DEHP can trigger an overactive immune response within the arterial walls, promoting chronic inflammation. Chronic inflammation is a well-established driver of atherosclerosis, which can precipitate heart attacks and strokes. These pathophysiological cascades initiated or amplified by phthalate exposure offer a plausible biological explanation for the epidemiological patterns observed in the current study.
The economic implications of this chemical-induced health burden are equally alarming. The researchers estimate that the global mortality tied to DEHP exposure could entail economic costs ranging from $510 billion to as high as $3.74 trillion. This encompasses medical expenditures, lost productivity, and broader societal impacts associated with premature cardiovascular mortality. Highlighting these staggering figures serves to reinforce the urgency for public health interventions aimed at reducing phthalate exposure at the population level.
Importantly, the study’s authors caution that their analysis focused exclusively on DEHP among a broader class of phthalates, implying that the true toll of phthalate-induced cardiovascular disease may be substantially higher. Additionally, the research scope was confined to adults aged 55 to 64, excluding potential mortality effects in younger or older age groups as well as non-cardiovascular health outcomes. This conservative approach suggests that the reported figures represent a lower-bound estimate of the overall health impact imposed by phthalate exposure.
The research team’s pioneering work represents the first global quantification of any health outcome attributable to phthalate exposure, setting a new benchmark for environmental epidemiology. Their methodology, which integrates biomonitoring data with mortality statistics on an unprecedented scale, exemplifies the power of interdisciplinary approaches in unraveling complex environmental health challenges. Such comprehensive assessments are vital for informing policymaking and regulatory actions worldwide.
Looking forward, the researchers express intent to expand their investigations to evaluate how reducing phthalate exposures might influence cardiovascular mortality trends in the future, potentially informing risk mitigation strategies. Furthermore, they aim to explore other adverse health effects linked to phthalate exposure, including reproductive toxicity and adverse birth outcomes such as preterm delivery. This ongoing work promises to deepen understanding of the broad implications of plastic-associated chemical exposure on human health.
The study’s lead and senior authors stress the pressing need for coordinated global regulatory frameworks to limit phthalate use and exposure, especially in regions experiencing rapid industrialization and rising plastic consumption. By establishing evidence-based causal pathways and quantifying associated health burdens, the research provides a compelling rationale for proactive measures to protect vulnerable populations and reduce environmental toxins that jeopardize cardiovascular health.
With phthalates entrenched in everyday consumer products and manufacturing processes, this landmark research underscores the insidious ways in which industrial chemicals can infiltrate biological systems and silently erode public health. It calls for a paradigm shift in how environmental exposures are integrated into cardiovascular disease risk models and public health strategies, emphasizing the critical intersection of chemical safety and chronic disease prevention in the 21st century.
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Subject of Research: People
Article Title: Phthalate exposure from plastics and cardiovascular disease: global estimates of attributable mortality and years life lost
News Publication Date: 29-Apr-2025
Web References: https://public.tableau.com/app/profile/sara.hyman2333/viz/GlobalmapofexcessCVmortDEHP/Dashboard1
References: DOI 10.1016/j.ebiom.2025.105730
Keywords: Endocrine disruptors, Medical economics, Environmental health, Mortality rates, Heart disease, Environmental illness, Plastics, Cardiovascular disease, Health disparity
