Phthalates, commonly added to plastics to make them more flexible and durable, may be contributing to a significant rise in heart-related deaths.
Published May 05, 2025 | 7:00 AM ⚊ Updated May 05, 2025 | 7:00 AM
Synopsis: Over 1 lakh Indians aged 55–64 died in 2018 from heart disease linked to phthalates, plastic chemicals widely used in packaging and consumer products, making India the worst-affected country globally, according to a Lancet study. Researchers attributed the high mortality to poor regulatory enforcement, rapid industrialisation, and increasing use of plastics in food, cosmetics, and medical items.
The plastic containers in your kitchen or the shiny wrappers around your snacks offer incredible convenience. But according to a major global study, they could also be increasing your risk of heart disease.
The paper, published in the journal Lancet eBiomedicine, found phthalates – chemicals commonly added to plastics to make them more flexible and durable – to be linked to a significant rise in heart-related deaths, with India facing the world’s highest toll.
Urban residents face higher risk because of greater consumption of packaged foods and more frequent use of plastic containers. Women were found to be particularly vulnerable, likely due to higher use of phthalate-containing products such as makeup, perfumes and lotions.
Researchers looked at health data across multiple continents and found that exposure to a specific plastic additive called di(2-ethylhexyl) phthalates (DEHP) was associated with over 1 lakh deaths in India (103,587) among people aged 55 to 64 – far surpassing China (60,937 deaths) and Indonesia (19,761 deaths).
What is more, India lost a staggering 2.9 million years of life (YLL) due to phthalate-linked cardiovascular deaths – the highest in the world. That is years of life cut short because of everyday exposure to toxic chemicals hidden in packaging, personal care products and medical devices.
The study, led by researchers at NYU Langone Health, pointed out that exposure has been shown in other studies to prompt an overactive immune response (inflammation) in the heart’s arteries, which, over time, is associated with an increased risk of heart attack or stroke.
The authors estimated that DEHP exposure contributed to 356,238 deaths, or more than 13 percent of all global mortality from heart disease in 2018 among men and women aged 55 through 64.
“By highlighting the connection between phthalates and a leading cause of death across the world, our findings add to the vast body of evidence that these chemicals present a tremendous danger to human health,” said study lead author Sara Hyman, Associate Research Scientist at NYU Grossman School of Medicine, in a statement.
According to the authors, the resulting economic burden from the deaths identified in their study was estimated to be around $510 billion and may have reached as high as $3.74 trillion.
Phthalates are used to make plastics soft and flexible. They are found in plastic food containers and wrappers, processed and packaged foods, soaps, shampoos, cosmetics, perfumes, medical tubes, intravenous (IV) bags and blood storage units.
Phthalates can leach out of products and enter the human body through food, skin contact or by breathing in dust. Once inside, they can interfere with hormones, cause inflammation in blood vessels, and affect how fat is stored – all of which increase the risk of heart attacks, strokes and hypertension.
For the research, the team used health and environmental data from dozens of population surveys to estimate DEHP exposure across 200 countries and territories. The information included urine samples containing chemical breakdown products left by the plastic additive. Mortality data was obtained from the Institute for Health Metrics and Evaluation, a research group in the United States that collects medical information worldwide to identify trends in public health.
The study highlighted India as a global hotspot for phthalate-linked deaths and disease. Despite having a smaller ageing population than China, India saw around 70 percent more DEHP-related deaths.
Reasons likely include high exposure through unregulated plastics in food, cosmetics and medical products, along with rising use of packaged and processed foods.
“The implications of our findings are particularly relevant for countries with high levels of industrialisation and plastic consumption. This analysis aligns with global trends in plastics production and regulation. For example, India has a rapidly expanding plastics industry, and faces substantial phthalate exposure risks due to plastic waste and the extensive use of commonly DEHP-inclusive plastics, such as polyvinyl chloride (PVC), in manufacturing of consumer goods,” said the study.
It also points to weak enforcement of safety standards for plastic materials and limited awareness among the public and healthcare systems.
“A recent 2024 study found that India emitted the highest volume of plastic emissions, totalling 9.3 million metric tonnes per year. The regions with the highest plastic emissions globally were identified as Southern Asia, Sub-Saharan Africa and Southeastern Asia – findings that suggest consistency with the global disease burden model. India has incorporated DEHP restrictions into its food packaging sector, but these regulations have been very recent,” reads the study.
India’s elderly population (aged 55 to 64) is also rising rapidly, increasing the number of people vulnerable to chronic diseases such as heart disease.
A possible explanation, the authors say, is that these countries face higher rates of exposure to the chemicals, possibly because they are undergoing a boom in plastic production but with fewer manufacturing restrictions than other regions.
“There is a clear disparity in which parts of the world bear the brunt of heightened heart risks from phthalates,” said study senior author Leonardo Trasande in a statement. “Our results underscore the urgent need for global regulations to reduce exposure to these toxins, especially in areas most affected by rapid industrialisation and plastic consumption,” added Trasande.
Among the key findings, the study showed that losses in the combined region of East Asia and the Middle East and the combined region of East Asia and the Pacific accounted, respectively, for about 42 percent and 32 percent of the mortality from heart disease linked to DEHP.
(Edited by Dese Gowda)
