In 1921 cardiovascular disease (CVD) surpassed pneumonia/influenza to become the leading cause of death in the U.S. It has held that position ever since, including during the much-hyped Covid-19 pandemic.
Over one billion people are affected by CVD at any one time, and it was responsible for more than 17 million deaths in the most recent year with all data tabulated (2019).
That amounts to nearly one-third of all deaths worldwide.
In the U.S., the Centers for Disease Control and Prevention estimates that heart disease causes about one in every four deaths in the country.
As dismal as these numbers are, they’re actually an improvement. Even though CVD still holds the number one position, death rates from CVD have declined by 60% per capita since 1950.
These improvements are due in large part from recognition of key risk factors such as smoking, obesity, physical activity and unhealthy diets.
A threat greater than smoking?
Unfortunately, the past two decades has seen a new and previously unrecognized risk for CVD—exposure to plastic polymers and their chemical additives. And this new risk differs from the other CVD risks in one insidious way: while the other risks can be avoided by changing one’s lifestyle, plastics are virtually impossible to avoid.
Of particular concern are phthalates, and among phthalates one class known as di-2-ethylhexylphthalate (DEHP), are of greatest concern. DEHP is used to soften polyvinylchloride plastics and is ubiquitous around the world. These types of plastics are typically abbreviated as “PVC” in the common vernacular.
DEHP is the most common “disease burden model” used in cardiovascular studies because it is one of the most widely used and studied phthalates. Extensive human exposure has lead to robust data from biomonitoring surveys and epidemiological studies.
Some notable examples include:
• A 2011 Swedish study found “circulating levels of bisphenol A and phthalates are related to carotid atherosclerosis in the elderly.”
• A 2019 Taiwanese study concluded, “Phthalate exposure increases subclinical atherosclerosis in young population.”
• A 2023 review from Portugal examined all recent studies and found a link between phthalates and heart problems across all age groups—including increased risk for stroke, arrhythmia, hypertension and other problems.
• A 2024 Italian study found 60% of heart disease patients had microplastics present in their arteries; and, during a three-year follow-up, those patients had a 4½ times greater risk of heart attack, stroke and death.
Now a new peer-reviewed study has assessed the worldwide impact of phthalate exposure from plastics, and determined they are linked to more than 356,000 cardiovascular deaths annually. The researchers referred to the phthalate threat as a “substantial global health burden.”
The study was published in The Lancet’s eBioMedicine database in April 2025. According to the researchers, the study is the first to estimate heart disease deaths from exposure to DEHP.
Study details
To conduct the study the researchers culled environmental and health data from 200 countries and territories and evaluated the varying DEHP exposure. This data was then compared to mortality data from the Institute for Health Metrics and Evaluation, an independent population health research organization.
The researchers estimated DEHP exposure contributed to 356,238 deaths, representing 13% of all global deaths from heart disease in 2018 among people aged 55 to 64. In evaluating the financial impact, the authors calculated that the premature deaths caused a $510 billion economic burden.
Importantly, the researchers noted their study does not independently prove DEHP causes heart-related deaths. The study was academic research; not a placebo-controlled trial. However, the study does add to the existing evidence—including other types of studies—linking microplastics to an increased risk of heart disease.
It’s not entirely clear how phthalates impact the heart. But the researchers, who are based at New York University Grossman School of Medicine, noted that phthalates increase oxidative stress and disrupt receptors that are crucial for metabolism. Both of these biological mechanisms have been linked to heart disease and other heart problems.
While the focus of the current study is cardiovascular disease, it is certainly not the only health concern linked to microplastics. Microplastics toxicity has also been shown to increase the risk of dementia, stroke, fertility issues and digestive disorders.
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Optimal Chemzyme from Optimal Health Systems provides a potent formula developed to address the alarming increase of microplastics found in the modern environment.
A unique enzyme known as Phthalazyme is a critical part of this formula since it is the first enzyme—and remains the only one—specifically designed to digest and detoxify the phthalates found in plastics.
To learn more about Phthalazyme check out our previous post here.
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Sources: TheLancet.com (2025 study).
