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Recent review unravels phthalates’ role in heart disease

Recent review unravels phthalates’ role in heart disease

Phthalates are essential elements within the plastics sector and, because of this, are sometimes found as contaminants throughout the encircling environment. Inside the environment, phthalates can disrupt endocrinal functions by being readily absorbed by humans and binding with molecules that interfere with the hormonal imbalance. Thus, phthalate exposure can result in a wide range of diseases, particularly cardiovascular diseases (CVDs), across ages.

In a recent review published within the Journal of Hazardous Materials, researchers review existing data on the impact of phthalate exposure on cardiovascular health.

Study: Phthalates’ exposure results in an increasing concern on cardiovascular health. Image Credit: Fer Gregory / Shutterstock.com

In regards to the review

Databases corresponding to the Web of Science, Scopus, and PubMed were looked for relevant records published between 2015 and April 2022. Only human experimental or epidemiological studies that included men and women and assessed the impact of phthalate exposure on CVD risks amongst individuals of all ages were included. Non-human studies, duplicate records, inaccessible records, and studies published in non-English languages were excluded.

What are phthalates?

Phthalates are chemicals categorized by the US Environmental Protection Agency (EPA) as priority environmental polluting substances.

High-molecular weight phthalates are used to enhance the elasticity and suppleness of polymers corresponding to polyvinyl chloride (PVC) in various industrial and household products, corresponding to furniture, tiles, adhesives, paints, rainwear, shower curtains, automobile upholstery, footwear, dust, food packaging, medical devices, diapers, and toys. Low-molecular-weight phthalates are used as additives and solvents in paints, sinks, and private care products, corresponding to cosmetics.

Phthalates are able to leaching into the environment, as they don’t bind covalently to polymers. Phthalates have been identified in water, air, food, consumer products, and biological fluids corresponding to blood, urine, amniotic fluid, saliva, and human milk.

Inhalation, ingestion, and absorption through the skin are the first exposure routes. Nevertheless, prenatal and intravenous exposure during medical interventions can be concerning.

Effects of phthalate exposure on cardiovascular health

Exposure to certain phthalates, including monomethyl phthalate (MMP) and monobenzyl phthalate (MBzP), may promote atherosclerosis by facilitating carotid artery plaque formation and altering carotid intima-media thickness (CIMT).

Bis(2-ethylhexyl) phthalate (DEHP) exposure promotes endothelial cell apoptosis, alters deoxyribonucleic acid (DNA) methylation, and facilitates atherosclerosis because of pro-atherogenic and pro-senescence activities, with cholesterol efflux inhibition through altered microRNA 200 c (miR200c)-5p-ATP-binding cassette sub-family A member 1 (ABCA1) activity. DEHP also upregulates plasminogen activator inhibitor type 1 expression and has procoagulant effects.

Phthalates like DEHP and di-n-butyl phthalate (DBP) metabolites, including mono-2-ethylhexyl phthalate (MEHP), monobutyl phthalate (MBP), and mono-isobutyl phthalate (MiBP) can increase the degrees of atherothrombotic markers corresponding to fibrinogen, plasma D-dimer, and high-sensitivity C-reactive protein amongst coronary artery disease (CAD) patients.

Phthalates like MEP alter blood pressure by potentiating peroxisome proliferator-activated receptor gamma (PPARγ) activity and inhibiting the renin-angiotensin-aldosterone system (RAAS). Interestingly, maternal exposure to phthalates reduces blood pressure (BP) within the offspring, whereas direct exposure to phthalates amongst children increases BP. As well as, MEP exposure increases the danger of pre-eclampsia because of enhanced soluble fms-like tyrosine kinase-1 and placental growth factor ratios (sFlt-1/PlGF), increased oxidative stress, and inflammatory cytokine production.

DEHP alters cardiac electrical conduction by decreasing the expression of genes related to cardiac cell electrical activity and calcium transport, including connexin 43, calponin, and calsequestrin, and reducing calcium levels within the sarcoplasmic reticulum.

Phthalate exposure, especially DEHP, may result in impaired recovery amongst patients who undergo cardiac surgeries because of decreased cell viability and mitochondrial membrane potential, increased lactate dehydrogenase (LDH) leakage, and reactive oxygen species (ROS) production, promoting apoptosis in cardiomyocytes.

Exposure to certain phthalate, especially MBP, may result in stroke because of glycolytic pathway disruptions and inhibition of proteins related to DNA transcription and ribonucleic acid (RNA) biogenesis. As well as, phthalates increase cardiometabolic risks corresponding to diabetes by increasing gestational weight gain, impairing glucose tolerance, increasing insulin resistance, and altering pyrimidine, amino acid, and galactose metabolism.

Phthalate exposure can also cause obesity because of increased triglyceride and total levels of cholesterol. As well as, phthalates disrupt hormonal balance because of their anti-androgenic, estrogenic, and anti-thyroid effects.


Based on the review findings, CVDs may develop amongst individuals of all ages and sexes who’re steadily exposed to phthalates.

Phthalate consumption may very well be reduced by minimizing the intake of canned and packaged foods and using stainless-steel, porcelain, glass, or eco-friendly ‘green’ products as a substitute of plastic ones. Most of the people must even be educated on the harmful effects of phthalates and their presence in various daily-use products and the environment.

Journal reference:

  • Mariana, M., Miguel Castelo-Branco, M., Soares A. M., & and Cairrao, E. (2023). Phthalates’ exposure results in an increasing concern on cardiovascular health. Journal of Hazardous Materials. doi:10.1016/j.jhazmat.2023.131680


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