The results of a newly reported study have shown that people who suffered a serious heart attack had higher levels of micro- and nanoplastics (MNPs) in their blood, compared with MNP levels in patients diagnosed with chronic ischemic heart disease and those who have normal blood vessels supplying the heart. The study findings also revealed that people who smoke and people exposed to higher levels of air pollution had higher levels of micro- and nanoplastics in their blood.
Headed by teams at Sapienza University of Rome, at the University of Verona, and at the Research Centre on Environmental Pollution and Cardiovascular Diseases at the University of Campania “Luigi Vanvitelli,” the study included 61 patients at Sant’Andrea University Hospital or Azienda Ospedaliera Universitaria Integrata of Verona, diagnosed with either a heart attack, chronic ischemic heart disease, or normal coronary arteries.
The researchers say their study adds to growing evidence that environmental pollution may affect cardiovascular health. Research lead Emanuele Barbato, MD, PhD, at Sapienza University of Rome, said, “These findings do not prove that microplastics cause heart attacks, but they reveal a strong association between environmental exposures, microplastics in the blood and cardiovascular disease. In our study, smoking history was strongly linked to microplastics in the blood. Our findings suggest that smoking might make it easier for micro and nanoplastics to enter the blood stream via the lungs. Air pollution may act in a similar way.”
Barbato is director of the Cardiology Unit of Sant’Andrea University Hospital, Rome, Italy, and senior author of the team’s published paper in European Heart Journal, titled “Micro- and nano-plastics in the coronary circulation and air pollution exposure in ischemic heart disease presentation.”
Cardiovascular diseases are increasingly related to lifelong environmental exposures, the authors noted. Among such exposures, MNPs are ubiquitous environmental pollutants, and evidence is increasing that they accumulate in human tissues following exposure and are emerging as a risk factor for health. Pasquale Paolisso, MD, PhD, at Sant’Andrea Hospital Sapienza University of Rome, said, “Micro and nanoplastics are tiny plastic particles that are found virtually everywhere in the environment, including the air we breathe, the water we drink, and many foods we consume. In recent years, scientists have begun to detect these particles in human tissues and organs, raising concerns about their potential health effects.”
Research findings have raised concerns about the potential role that MNPs may play in cardiovascular diseases. “Emerging evidence indicates that MNPs, once considered inert contaminants, are biologically active pollutants contributing to the pathophysiology of cardiovascular diseases, particularly by promoting the development and progression of atherosclerotic plaques and potentially triggering adverse cardiovascular events,” the team stated.
However, as Paolisso further noted, “… very little was known about whether these particles are present in the coronary circulation—the blood flowing through the arteries that supply the heart—or whether environmental exposures such as smoking and air pollution might influence their presence.” As the authors explained, “… current knowledge is predominantly based on in vitro experiments and preliminary ex vivo findings, highlighting the need for in vivo and clinical investigations.”
For their newly reported study the team measured MNPs in coronary and peripheral blood, in 61 patients at Sant’Andrea University Hospital or Azienda Ospedaliera Universitaria Integrata of Verona, who were undergoing coronary angiography for suspected coronary artery disease (CAD). Patients were stratified as those with ST-segment elevation myocardial infarction (STEMI), chronic coronary syndromes (CCS) and controls with normal coronary arteries.
As well as taking blood samples from the vessels supplying the heart and from elsewhere in the body, the team collected data on whether the patients were smokers and their exposure to pollution, both on the day of testing and over the preceding two years. Coronary micro and nanoplastics were analyzed at the Research Centre for Environmental Pollution and Cardiovascular Diseases, University of Campania ‘Luigi Vanvitelli,’ a center dedicated to understanding how environmental pollutants influence cardiovascular health.
The results showed that micro and nanoplastics were detected in 84% of patients diagnosed with heart attack, compared with 40% of patients with chronic ischemic heart disease and 32% of patients with normal coronary arteries. “The observation that IL-6 and TNF-α concentrations were highest in STEMI patients, particularly within the coronary circulation, and were more elevated in the presence of detectable MNPs supports an exploratory association between MNP burden and a localized pro-inflammatory milieu in patients with obstructive CAD,” the investigators suggested.
Heart attack patients also had a greater variety of plastic types in their blood. The most common type of plastic was polyethylene (PE), which is commonly used in packaging and consumer products. “Across all study cohorts, PE was the most frequently identified polymer, being present in 97% of the patients with detectable MNPs,” the investigators added.
Patients exposed to higher long-term levels of air pollution (PM2.5; particles measuring 2.5 μm or less in diameter) were more likely to have microplastics in their blood, and smokers were six times more likely to have microplastics in their blood. All patients who were smokers and were exposed to higher air pollution levels had plastics in their blood, compared with only 12.5% of patients who did not smoke and were not exposed to higher levels of air pollution. “MNPs, PM2.5, and smoking constitute potentially modifiable environmental risk factors for cardiovascular diseases, with significant implications for public health and cardiovascular disease prevention,” the scientists stated. “Future research should aim to quantify individual MNP exposure, assess combined pollutant burden, and validate interventions that target this expanded network of environmental cardiovascular hazards.”
Barbato added, “The results highlight the need to consider microplastic pollution as part of the broader environmental determinants of health. Policies that reduce air pollution, tobacco exposure, and environmental plastic contamination could have benefits that extend beyond environmental protection and potentially improve cardiovascular health.”
In an accompanying editorial Andreas Daiber, PhD, at University Medical Centre of the Johannes Gutenberg University, Mainz, and colleagues pointed to the observation by Paolisso et al. of an association between NMP levels and exposure to air pollution and tobacco smoking. “While the underlying mechanisms remain unclear, this finding underscores a key principle: environmental exposures rarely occur in isolation,” Daiber and colleagues stated. “Individuals are exposed to multiple environmental stressors simultaneously, including air pollution, noise, chemical contaminants, plastics, and climate-related stressors, especially in the urban setting. These exposures may interact through shared biological pathways, leading to additive or synergistic effects on cardiovascular risk.”
And while substantial uncertainties remain, “the convergence of epidemiological, clinical, and mechanistic evidence suggests that plastic pollution may represent a previously underestimated cardiovascular risk factor,” Daiber et al. continued. “Addressing this challenge will require coordinated efforts across disciplines and policy domains. In the era of the Anthropocene, protecting cardiovascular health will increasingly depend on reducing not only traditional risk factors but also the growing burden of environmental pollutants (the detrimental part of the exposome), among which plastics may soon play a central role.”
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