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Daily contact with specific chemicals present in common plastic household items has been associated with over 356,000 deaths from heart disease globally in 2018, according to a recent analysis based on population surveys.
The chemicals in question, known as phthalates, are extensively utilized worldwide. Notably, regions such as the Middle East, South Asia, East Asia, and the Pacific have accounted for a disproportionate share of these fatalities—about three-quarters of the total deaths.
For many years, health specialists have linked phthalates, found in products ranging from cosmetics and cleaning agents to medical supplies and pest control substances, to various health issues. Research has indicated that when these chemicals decompose into tiny particles and enter the body, they are correlated with heightened risks for a variety of conditions, including obesity, diabetes, reproductive health issues, and cancer.
This study, led by researchers from NYU Langone Health, emphasized the risks associated with di-2-ethylhexyl phthalate (DEHP), a common plasticizer used to enhance the softness and flexibility of items like food containers and medical devices. Previous studies have shown that DEHP exposure can lead to increased inflammatory responses in the arteries, which over time may result in a higher likelihood of heart attacks or strokes. The current analysis estimates that DEHP exposure contributed to 356,238 heart disease-related deaths in 2018, which represents more than 13% of all heart disease mortality among people aged 55 to 64 years.
“Our findings reinforce the existing evidence that phthalates represent a significant threat to public health by linking them to a leading cause of mortality globally,” stated lead author Sara Hyman, BS, an associate research scientist at NYU Grossman School of Medicine.
The analysis revealed that the economic burden of these deaths could be as much as $510 billion, with estimates reaching up to $3.74 trillion.
A previous study conducted in 2021 associated phthalate exposure with over 50,000 premature deaths annually, primarily among older Americans, due to heart-related issues. This latest research is considered the first to provide a global estimate of the cardiovascular fatalities related to phthalate exposure, according to Hyman, who is also pursuing her graduate studies at NYU School of Public Global Health.
A comprehensive report based on these findings is set to be published online on April 29 in the journal Lancet eBiomedicine.
In conducting this research, the team analyzed health and environmental data from numerous population surveys to estimate DEHP exposure across 200 nations and territories. This required the collection of urine samples to identify chemical breakdown products associated with the plastic additive. Mortality statistics were sourced from the Institute for Health Metrics and Evaluation, which compiles medical data globally to track public health trends.
Key findings indicate that the East Asia and Middle East regions collectively contributed to approximately 42% of the DEHP-related heart disease mortality, while the East Asia and Pacific regions accounted for about 32%. Specifically, India recorded the highest number of deaths, tallying 103,587, followed by China and Indonesia. The elevated risks in these regions remained evident even after adjusting for population size within the defined age group.
The authors suggest that these countries may be experiencing higher exposure rates due to a surge in plastic manufacturing, often with fewer regulatory constraints than other parts of the world.
“Our study illustrates a striking disparity in the global distribution of heart disease risks related to phthalate exposure,” remarked senior author Leonardo Trasande, MD, MPP. “This underscores the urgent need for international regulations to mitigate exposure to these hazardous substances, especially in rapidly industrializing regions with increased plastic use,” added Trasande, who holds the Jim G. Hendrick, MD, Professorship in Pediatrics at NYU Grossman School of Medicine.
Trasande noted that while the analysis sheds light on the correlation between DEHP and heart disease, it does not assert that DEHP is the sole factor behind these health risks, nor does it encompass other types of phthalates or mortality data from different age groups. Therefore, the total deaths from heart disease linked to these chemicals are likely to be significantly higher.
The researchers are planning to further investigate how reductions in phthalate exposure may affect global mortality rates over time, as well as extend their research to other health risks associated with these chemicals, such as preterm birth. Trasande also leads the NYU Grossman School of Medicine’s Division of Environmental Pediatrics and the Center for the Investigation of Environmental Hazards.
The study received funding from the National Institutes of Health grant P2CES033423, with additional support provided by Beyond Petrochemicals.
Trasande has reported receiving travel support or attending meetings organized by various health and environmental organizations, and has received royalties from publisher partnerships. However, none of these affiliations influenced the current study. All relationships are managed by NYU Langone Health.
Alongside Hyman and Trasande, other NYU Langone researchers contributing to the study include Jonathan Acevedo, MPH, and Chiara Gianarelli, MD, PhD.
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