Plastics can break your heart
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| Theoretically, a complete phaseout of fossil fuels could prevent up to 82% of all avoidable deaths from human-caused air pollution, the review found. (Credit: European Society of Cardiology) |
Global analysis shows the “profound impact” of pollution and
other environmental hazards on cardiovascular health
Cardiovascular disease—the world’s leading cause of death—is
increasingly driven by polluted air, toxic chemicals, plastics, noise, and
extreme temperatures, according to a sweeping new review in Cardiovascular Research that
calls for stricter environmental regulations to protect public health.
Heart attacks, strokes, arrhythmias, and heart failure
killed more than 20 million people in 2021, accounting for nearly one-third of
all global deaths. The new analysis by a team of international scientists found
increasing evidence that hazardous exposures are a major culprit in millions of
these deaths worldwide each year, especially among vulnerable
populations.
Air pollution, the most significant environmental risk,
contributes to approximately 8.3 million deaths annually, with more than half
due to cardiovascular disease (CVD), while two million people lost their lives
in 2019 due to chemical exposures from contaminated soil and water.
While these drivers may appear unrelated, they are all forms
of pollution—particularly from industry-produced toxins.
Chemicals used in pesticides and phthalates in plastics, for instance, have been linked to
heart damage and increased cardiovascular disease risk.
Meanwhile, fine particulate matter (PM2.5)—particles less
than 2.5 micrometers in diameter, primarily from fossil fuel emissions—can
worsen and contribute to the development of cardiovascular disease. Tiny
particles can enter the lungs and bloodstream, causing cell damage, blood
vessel injury, and atherosclerosis (narrowing and hardening of arteries), all
of which contribute to a higher
risk of blood clots, heart attacks, and strokes.
Theoretically, a complete phaseout of fossil fuels could
prevent up to 82% of all avoidable deaths from human-caused air pollution, the
researchers found.
“This comprehensive review…underscores the reality that environmental risk factors are major but insufficiently appreciated risk factors for CVD,” they said. “The evidence underscores the urgent need for targeted public health interventions and policy actions. Individual interventions and behavioral change are not sufficient to address these risks.”
As central drivers of the global cardiovascular disease
epidemic, chemical pollutants should be treated as seriously as traditional
health risk factors such as smoking, poor diet, and lack of exercise, the
researchers said. Tobacco
smoking caused 7.7 million deaths worldwide in 2019, a Lancet study
showed.
“These factors contribute to a global disease burden,
necessitating immediate and coordinated action at a societal level across
disciplines and policy sectors,” the authors said.
Pollution and toxic chemicals fuel cardiovascular disease
Scientists in the U.S., U.K., Germany, Denmark, and Spain
conducted the review. Its highlights include:
- Air
pollution contributed to 8.3 million early deaths, with nearly 60%
directly linked to heart disease, making it the second-leading global risk
factor for death after high blood pressure (hypertension). Both
short- and long-term exposures to polluted air are tied to hardened
arteries, high blood pressure, abnormal cholesterol, strokes, and sudden
cardiac events.
- Every
5 micrograms per cubic meter increase in annual PM2.5 was
linked to a 13% rise in acute coronary events, while each 10 microgram
increase in PM2.5 and PM10 was tied to
higher rates of hospitalization and death from heart failure. Even
in areas with relatively low levels of pollution, such as Tasmania, spikes
in PM2.5were associated with rising cases of heart
failure.
- Patients
with microplastics (MNPs) in arterial plaques faced a 4.5-fold higher risk
of heart attack, stroke, or death within three years. Micro-
and nanoplastics may damage blood vessels by triggering cell
damage and inflammation, harming blood vessels, and accelerating cell
aging—mechanisms central to CVD, preclinical studies showed. They also may
act as carriers for toxic chemicals such as phthalates, bisphenol
A (BPA), PFAS,
and heavy metals, amplifying cardiovascular risk. In addition, they may
promote clotting and red blood cell damage, further raising
the likelihood of complications.
- Endocrine-disrupting
chemicals such as PFAS, BPA, and dioxins increase
cardiovascular risk by disrupting metabolism, triggering cell and tissue
damage, and fueling inflammation. BPA has been linked to higher rates
of heart disease, hypertension, and heart failure, while PFAS contributes
to artery disease. Widely used organophosphate pesticides are tied
to dangerous heart rhythms, and other pollutants, including polycyclic
aromatic hydrocarbons (PAHs, chemicals formed when coal, oil, gas, wood,
garbage, or tobacco are burned), are also increasingly associated with
cardiovascular diseases.
- Lead
exposure contributes to more than 5.5 million CVD deaths annually. Heavy
metals—many released through mining, smelting, coal burning, and other
industries, contaminating food, air, and water—are major contributors to
cardiovascular disease. Even low levels of lead raise blood pressure and
death risk, while cadmium is tied to artery disease, atherosclerosis, and
heart failure through oxidative stress and blood vessel damage.
Methylmercury increases the risk of artery narrowing and heart attack,
copper promotes atherosclerosis through cell death, and arsenic is linked
to early artery thickening and heart disease.
Evidence of harm grows, while heart health protections
lag
The analysis builds on recent evidence associating
cardiovascular health harms with environmental factors, even when exposure to
toxins occurs below existing safety limits.
One 2024 study from Italy, for instance, linked long-term
exposure to water contaminated with per- and polyfluoroalkyl substances (PFAS,
or “forever chemicals”) to a significant increase in cardiovascular-related deaths,
while two others involving over 60 million Americans aged 65 and older revealed
that even PM2.5 exposure levels deemed ‘safe’ significantly
increased cardiovascular hospitalizations by about 29%.
Long-term air pollution exposure may also severely worsen the risk of dangerous
blood clots in deep veins, another study showed.
The new findings also come at a time when the EPA has
proposed delaying and narrowing drinking water limits for key PFAS,
despite new data that shows more than 172 million Americans are exposed to these
chemicals in U.S. drinking water. The agency is also moving to repeal the legal
basis for regulating greenhouse gases, and has extended industry
compliance deadlines and granted exemptions to coal and industrial plants,
prompting concerns about weaker
oversight of toxic chemicals and air pollution.
Noise, extreme temperatures, and knowledge gaps
The research team also pointed to other types of
environmental stressors that may impact cardiovascular health, though more
information is needed. These include:
- Chronic
noise from traffic, trains, and aircraft can stress hormones,
disrupt sleep, and worsen risk factors such as high blood pressure,
diabetes, and obesity, increasing the risks of high blood pressure, heart
attack, and stroke. In Europe, tens of thousands of new cardiovascular
cases each year are attributed to transport noise, with researchers
warning the same is likely true in US cities.
- Climate
change may compound health risks: Heat waves worsen smog, cold
snaps strain the heart, and pollutants such as black carbon and methane
both damage the cardiovascular system and fuel global warming, the review
showed.
Despite extensive evidence, significant knowledge gaps
remain, the researchers said. The long-term effects of lifelong noise exposure
are not fully understood, nor are the risks of very low pollution levels.
Few studies examine how multiple pollutants interact, even though people are routinely exposed to them together. Threats such as wildfire smoke, desert dust storms, and artificial nighttime light also remain underexplored.
Population-based studies of micro- and nanoplastics and
heart health are particularly needed, given their widespread presence, the scientists said. They also warned
that most of the many thousands of manufacturer chemicals in use have never
been tested and should be subjected to the same degree of regulatory scrutiny
as pharmaceutical chemicals, they said.
Without even the most basic information on the potential
toxicity of these widely used materials, it is impossible to estimate the
magnitude of their harms to health,” the authors said.
Stronger policies could save millions of lives
City-level policies show promise, the researchers said.
London’s Ultra Low Emission Zone is projected to prevent more than 1.4 million
hospital admissions by 2050, while Bradford, England, has saved more than
£30,000 (the equivalent of US$40,500) a month in national healthcare costs
after introducing clean air zones. Similar measures are being considered in
U.S. cities, but progress is slower.
At the global level, transitioning to 100% renewable energy
system—dominated by solar and wind power—could cut major pollutants such as
nitrogen oxides, sulfur dioxide, and fine particulate matter by up to 99% by
2050, delivering what the review called “double benefits” for both climate and
heart health. Even smaller reductions than a complete phaseout of fossil
fuel-related emissions would still deliver major cardiovascular health gains,
the authors said.
Mitigation requires systemic interventions such as stricter
pollution standards, noise regulations, sustainable urban design, and green
infrastructure, they said. It should also include the adoption of innovative
methods to measure tiny air pollutants and airborne chemicals on a large scale,
particularly in cities where population exposure is highest.
“To reduce the cardiovascular burden of environmental risk
factors, governments must adopt proactive and enforceable policies that
prioritize public health, environmental sustainability, and equitable access to
protective measures,” they concluded. “Integrating environmental determinants
into CVD prevention strategies is essential to reducing morbidity and mortality
on a global scale.”
Reference
Münzel T, Sørensen M, Lelieveld J, et al. A comprehensive review/expert statement on environmental risk
factors of cardiovascular disease. Cardiovascular Research.
Published online August 11, 2025. doi:10.1093/cvr/cvaf119
