Phthalates are commonly used in plastics, including food contact articles, to increase the material’s flexibility and processability. They have been linked to several health outcomes, including cardiovascular disease (FPF reported, here, and here), but the attributable global mortality was so far unknown.
In an article published in July 2025, in the peer-reviewed Lancet journal eBioMedicine, Sara Hyman and co-authors from the NYU Langone Medical Center and New York University, USA, calculated the global cardiovascular mortality attributable to the most widely used phthalate, di-2-ethylhexylphthalate (DEHP, CAS 117-81-7) for the year 2018. The scientists estimated that 356,238 global deaths, or 13.5% of all premature cardiovascular deaths in adults between 55 and 64 years, in 2018, are associated with DEHP exposure. 349,113 deaths were attributed to plastic use. Overall, DEHP exposure resulted in 10,473 million years of life lost.
The authors further reported that phthalate exposure is ubiquitous and contributes to cardiovascular mortality in all world regions. “The burden was heightened, not only in countries with developing plastics industries and waste management systems, but also in countries with ageing populations.” In the Middle East and South Asia, effects were most pronounced, with 16.8% of cardiovascular deaths associated with DEHP exposure. Of the 356,238 deaths, 71.2% occurred in South Asia, the Middle East, and East Asia.
These “findings underscore the need for urgent global and local regulatory interventions to curb mortality from DEHP exposure,” Hyman and co-authors concluded.
Using data from the Institute for Health Metrics and Evaluation (IHME), the scientists considered cardiovascular mortality rates for 55–64-year-olds from 200 countries in their analysis. Exposure data of the DEHP metabolites, mono (2-ethylhexyl) phthalate (MEHP, CAS 4376-20-9), mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP, CAS 40321-99-1), mono (2-ethyl-5-carboxypentyl) phthalate (MECPP, CAS 40809-41-4), and mono (2-ethyl-5-oxohexyl) phthalate (MEOHP, CAS 40321-98-0), were collected from publicly available sources such as the USA’s National Health and Nutrition Examination Survey (NHANES) (FPF reported here, here, and here). Based on these data, Hyman and co-authors calculated hazard ratios of cardiovascular mortality as well as excess deaths and years of life lost due to DEHP exposure.
Researchers from NYU Langone Medical Center have previously analyzed the mortality of US adults due to phthalate exposure and associated costs (FPF reported). Health costs have also been estimated for the exposure to other groups of chemicals, including per- and polyfluoroalkyl substances (PFAS) (FPF reported) and endocrine-disrupting chemicals (EDCs) (FPF reported and here).
Reference
Hyman, S. (2025). “Phthalate exposure from plastics and cardiovascular disease: global estimates of attributable mortality and years of life lost.” eBioMedicine. DOI: 10.1016/j.ebiom.2025.105730
Read more
CNN (April 30, 2025). “Common household plastics linked to thousands of global deaths from heart disease, study finds.” Sandee LaMotte
The New York Times (April 29, 2025). “A new study raises alarms about plastics and heart disease. Here’s what to know.”
