According to a new global analysis, daily exposure to certain chemicals used in the manufacture of plastic household items may have contributed to over 356,000 deaths from heart disease worldwide in 2018. Researchers found that phthalates—chemicals used to soften plastics—were widely implicated. Although these substances are commonplace across the globe, regions such as the Middle East, South Asia, East Asia, and the Pacific carried a disproportionately high burden, accounting for nearly three-quarters of the total deaths linked to exposure.
Phthalates have long been associated with health problems, including obesity, diabetes, infertility, and cancer. Found in cosmetics, detergents, plastic pipes, insect repellents, and many other products, these chemicals degrade into microscopic particles that are easily ingested or absorbed. In this latest study, led by researchers at NYU Langone Health, the focus was on a specific phthalate, di-2-ethylhexyl phthalate (DEHP), commonly used in food containers and medical devices. Prior studies have already indicated that DEHP can trigger inflammation in the arteries, increasing the long-term risk of heart attacks and strokes.
The research team estimated that DEHP exposure alone was responsible for 356,238 deaths globally among men and women aged 55 to 64 in 2018, representing over 13% of heart disease mortality in that age group. Sara Hyman, the lead author and an associate research scientist at NYU Grossman School of Medicine, stated that their findings reinforce the mounting evidence of the serious health risks of phthalates. She emphasised that the connection between everyday chemical exposure and one of the world’s leading causes of death demands urgent attention from both the public and policymakers.
The economic impact of these deaths is staggering. The study calculated that the resulting financial burden could amount to around $510 billion and possibly as much as $3.74 trillion globally. This builds on a previous 2021 study by the same team, which linked phthalates to over 50,000 premature deaths annually among older Americans. However, the current investigation is believed to be the first to produce a worldwide estimate of cardiovascular deaths—or any health outcome—caused by exposure to phthalates.
Data for the study were gathered from dozens of population surveys across 200 countries and territories. Researchers analysed urinary chemical markers left behind by DEHP and combined these with mortality statistics from the Institute for Health Metrics and Evaluation, a US-based research organisation. The findings revealed that East Asia and the Middle East accounted for 42% of heart disease deaths related to DEHP exposure, while East Asia and the Pacific together contributed 32%. India experienced the highest number of deaths, followed by China and Indonesia. These results remained significant even after adjusting for population sizes.
The authors suggest that higher exposure rates in these regions may be due to rapid industrialisation and widespread plastic production, often without strong regulatory controls. Senior author Dr Leonardo Trasande, Professor of Paediatrics and Environmental Medicine at NYU Grossman School of Medicine, stressed the disparity, noting that some countries bear far greater risks. He called for urgent global regulatory action to limit exposure, especially in areas where plastic use and industrial growth are surging without adequate safety measures.
While the study highlights a strong association between DEHP exposure and heart disease deaths, the researchers caution that causation cannot be definitively established. The analysis also did not account for deaths caused by other phthalates or among age groups outside the 55 to 64 range, suggesting that the actual impact may be even greater. Future research will focus on measuring the benefits of reduced phthalate exposure over time and investigating other health risks linked to these pervasive chemicals, such as preterm births. The authors hope their work will inspire urgent global efforts to mitigate the health dangers posed by plastic pollution.
More information: Sara Hyman et al, Phthalate exposure from plastics and cardiovascular disease: global estimates of attributable mortality and years life lost, EBioMedicine. DOI: 10.1016/j.ebiom.2025.105730
Journal information: EBioMedicine Provided by NYU Langone Health / NYU Grossman School of Medicine
