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Daily exposure to a phthalate commonly used in plastic products was linked to more than 356,000 cardiovascular deaths globally in 2018, research shows.

Daily exposure to di-2-ethylhexylphthalate (DEHP)—a phthalate commonly used in plastic products—was linked to more than 356,000 cardiovascular deaths globally in 2018, with about three-fourths of those deaths occurring in the Middle East, South Asia, East Asia, and the Pacific, according to a study published in eBioMedicine.

“Plastics pose a significant risk to increased cardiovascular mortality, disproportionately impacting regions which have developing plastic production sectors,” wrote lead study author Sara Hyman, MS, NYU Grossman School of Medicine, and colleagues.

Phthalates have been linked to increased oxidative stress, metabolic dysfunction, and cardiovascular disease (CVD). DEHP is commonly found in food packaging, furniture, shoes, flooring, shower curtains, medical equipment, and many other products. The study offered the first global estimate of cardiovascular deaths attributable to DEHP exposure and highlighted significant regional disparities in the impact of DEHP exposure.

Analyzing Data From 200 Countries

The systematic review and meta-analysis included data from 200 countries, using World Bank 2018 population estimates for individuals aged 55 to 64 years.

A mixed-effects regression model was employed to track phthalate metabolite concentrations over time, with the analysis stratified by region to assess regional trends in exposure. The researchers incorporated cardiovascular mortality data from the Institute for Health Metrics and Evaluation, alongside regional DEHP exposure estimates from various sources, including published studies and country-level cardiovascular mortality rates.

They found that, in 2018:

• Between 356,238 and 356,602 cardiovascular deaths worldwide were attributed to DEHP exposure, representing 13.5% of global cardiovascular deaths among people between 55 and 64 years of age.
• Globally, DEHP exposure resulted in 10,473,621 years of life lost (YLL).

According to the study, geographic disparities were significant, with the Middle East and South Asia experiencing the largest burden of DEHP-related cardiovascular deaths, accounting for 41.7% of global cardiovascular mortality in 2018. East Asia and the Pacific also had a high share, contributing to over 31% of global DEHP-attributable cardiovascular deaths.

Countries with large aging populations, such as India, China, and Indonesia, experienced the highest number of cardiovascular deaths due to DEHP exposure. In terms of YLL, Asia, particularly South Asia and East Asia, bore the largest share, with over 10.47 million YLL globally.

The study also highlighted the disproportionate burden faced by low- and middle-income countries, where higher levels of DEHP exposure were more consistent across different population groups.

Call for Global Research & Regulatory Action

The authors acknowledged the limitations of the study, including the possibility that the estimates from the literature on which they based their calculations may have been biased or confounded by other variables. Additionally, they focused solely on DEHP, although other plastic-related chemicals, such as bisphenols, DEHP replacements, and microplastics, have also been implicated in increased cardiovascular mortality.

“These data highlight critical global disparities in loss of life due to plastics pollution. The large mortality burden disproportionately borne in Asia and Africa, which are simultaneously experiencing growth in plastics consumption and production, should raise alarm in nations in these regions,” the authors wrote. “These findings underscore the critical need for enhanced regulatory measures and international cooperation to mitigate the health impacts of phthalates, particularly in regions characterized by high levels of industrialization and plastic consumption.”

The researchers concluded with a call for further related global research, stating, “Global estimates are needed to inform ongoing negotiations of a Global Plastics Treaty.”