Phthalates and Cardiovascular Risk: A Call for Awareness in Clinical Practice

Phthalates, widely used as plasticizers in industrial and medical products, are increasingly recognized as cardiovascular health disruptors. Their ubiquity poses a significant threat, particularly to patients with or at risk of cardiovascular disease. This review examines the multifactorial risks linked to phthalate exposure, including oxidative stress, epigenetic (re)programming, mitochondrial dysfunction, and endocrine disruption. Preclinical models - ranging from isolated cardiomyocytes to whole-animal systems demonstrate direct cardiotoxic effects, whereas epidemiological studies suggest a considerable global cardiovascular burden. Iatrogenic exposure through drug packaging, tubing, dialysis, and surgical equipment is especially concerning in frail patients yet remains underrecognized in clinical guidelines. Vulnerable populations such as neonates, pregnant women, and patients undergoing cardiovascular procedures may face disproportionately high exposure levels. Despite the availability of safer alternatives, regulatory responses are inconsistent and clinical awareness is limited. Further longitudinal studies and biomarker-based surveillance are needed to quantify cumulative risk. Addressing this overlooked hazard is essential to protect patients from preventable harm and promote safer, precision cardiovascular care in the era of pervasive plastic use. We call for urgent reassessment of current practices, integration of environmental toxicology into medical training, and systematic adoption of phthalate-free materials.