Page Last modified 22 Jun 2023
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Toxic chemicals like heavy metals, organic solvents, polycyclic aromatic hydrocarbons (PAHs), Benzene, PFAS and pesticides can affect cardiovascular health. We do not have enough data to calculate the overall contribution of our chemical exposure to cardiovascular disease in Europe, but we know that reducing our exposure to certain types of chemicals, like lead, can help reduce cardiovascular risk.

Chemicals and cardiovascular disease

Exposure to some of the chemicals present in European workplaces and/or released to the environment contribute to the cardiovascular disease burden. This can come either from direct exposure to chemicals at the workplace or through the products that we use, or through indirect exposure to chemicals that are released to the environment and enter our drinking water, food or air. These chemicals come in many forms and include heavy metals, organic solvents and chemical air pollutants like polycyclic aromatic hydrocarbons (PAHs), Benzene, PFAS and pesticides (Rovira et al., 2020; Meneguzzi et al., 2021). Many of these chemicals have other toxic effects, contributing to other illnesses such as cancer or respiratory diseases. In some cases they have already been found in potentially risky concentrations in samples from the general population, in the context of the European human biomonitoring initiative (HBM4EU, 2022). Box 2 highlights selected chemicals with known cardiovascular effects.

Box 2. How selected chemicals contribute to cardiovascular disease

Lead and other heavy metals: while the mechanisms are not fully understood (Yang et al., 2020), it is clear that exposure to heavy metals like arsenic, copper, cadmium and particularly lead cause or contribute to cardiovascular disease — specifically IHD, stroke and atrial fibrillation (Oberoi et al., 2019; Murray et al., 2020; Rovira et al., 2020; Sjörgren et al., 2020; Dai et al., 2022; Feigin et al., 2016; Feigin et al., 2021). Lead, for which the evidence of linkages with CVD is particularly strong, is responsible for over 2% of cardiovascular deaths on average in the EEA member countries[1] (GBD Collaborative Network, 2020; Vaduganathan M et al., 2022).

Benzene and PAHs: benzene and PAHs, both relatively common air pollutants, affect cardiovascular health, with known effects on rates of heart attack and hypertension (Rovira et al., 2020; Shiue, 2015). Most of the evidence on benzene, PAHs and CVD comes from occupational settings, where exposures tend to be much higher than in the general population (Mirzababaei et al., 2022).

Asbestos and crystalline silica: there is strong evidence that asbestos and CVD are associated, adding to its known cancer-causing and respiratory effects and further highlighting the need to eradicate all occupational and environmental asbestos exposures. The occupational inhalation of another mineral dust, crystalline silica, is also associated with CVD, specifically IHD (Sjörgren et al., 2020).

Other chemicals: there is evidence of adverse cardiovascular health effects from occupational exposures to carbon monoxide, mineral dusts, dioxins, and nitrated explosives (Sjörgren et al., 2020). The evidence on the links of pesticides and CVD is still limited, but several studies have found that environmental, and particularly occupational, exposures to several pesticides are associated with a higher risk of CVD (Sjörgren et al., 2020). Occupational exposure to commonly used pesticides, including chlorpyrifos and carbofuran, may increase the risk of acute myocardial infarction, whereas others like malathion and deltamethrin are associated with an increase in blood pressure. Environmental exposure to organochlorine pesticides is also associated with an increased risk of CVD (Zago et al., 2020; Wahab et al., 2017; Fu et al., 2020; Sekhotha et al., 2016).

Because of the enormous diversity of chemicals and exposures, and a lack of data, we are not certain about the overall contribution of chemicals to the burden of cardiovascular disease in European residents. Relatively few of the thousands of substances in our surroundings have been examined in epidemiological studies for their potential links to CVD. Furthermore, the existing tests that are normally required under the relevant chemical regulations (e.g. REACH, the Biocide Regulation, the Plant Protection Product Regulation, etc.) have very limited sensitivity to detect substances that can affect the cardiovascular system (Daley et al., 2023). This means that many chemicals on the market and in the environment have not undergone exhaustive toxicity testing, and significant knowledge gaps remain on the potential cardiovascular effects of low levels of exposure to combinations of chemicals throughout our lifetime.


Trends in exposure to chemicals in Europe

85% of European residents say they are worried about the impact of chemicals on their health (Directorate-General for Communication, 2020). In 2020, over 208 million tonnes of chemicals harmful to health were produced in the EU; this amount has not decreased significantly since 2004 (EUROSTAT, 2022; Persson et al., 2022). Moreover, some of the efforts to replace dangerous chemicals may have resulted in regrettable substitutions — when one chemical is used to replace another problematic one but turns out to be hazardous, too (Maertens et al., 2021). Exposure to toxic chemicals comes from multiple sources and pathways, including outdoor and indoor air pollution, smoking (either directly or second-hand), consumer products, drinking water and food, and in relation to different occupations. In a recent European Working Conditions Survey (Eurofound, 2021), over 21% of EU workers reported being often or always exposed to chemical products or substances. Many common toxic workplace chemicals are generated when carrying out specific tasks or applying specific technologies (cutting stone, grinding or cutting wood, welding, processing metal products, combustion, etc.) rather than substances that are marketed or used as such. For these and other workplace toxic chemicals, exposure is mainly reduced through prevention measures such as local exhaust ventilation.


What the EU is doing about toxic chemicals

The EU has a wide variety of policies, mechanisms and bodies intended to address the risks associated with chemicals in products and chemical mixtures. The EU chemicals strategy for sustainability aims to protect people and the environment from toxic chemicals. The recently published Restrictions Roadmap, meanwhile, aims to ensure implementation, which would in turn result in the largest regulatory restriction exercise ever seen for toxic chemicals.

The Regulation on the registration, evaluation, authorisation and restriction of chemicals (REACH Regulation) aims to better protect human health and the environment from the risks posed by chemicals. Under the REACH Regulation, companies manufacturing and marketing hazardous substances in the EU must demonstrate to the European Chemicals Agency (ECHA) how the substance can be safely used and provide risk management measures for users. Under the chemicals strategy for sustainability, the European Commission proposes a more integrated approach to chemical risk assessment. This especially applies to chemicals with similar hazards, risks or functions.

The European Food Safety Authority (EFSA) routinely carries out risk assessments on a wide range of substances in the food chain. The Farm to Fork strategy, for its part, intends to address the challenges of sustainability in food systems, including reducing the risks to human health and the environment from exposure to chemical pesticides and substances used in food manufacturing.

A comprehensive legislative framework sets out employers’ responsibility for the health and safety of workers. Employers must carry out a workplace risk assessment, and implement protective and preventive measures, following a hierarchy of prevention. This hierarchy first prioritises eliminating toxic chemicals, then substituting toxic chemicals with less hazardous substances, and finally where neither is possible, applying collective prevention measures such as using local exhaust ventilation or limiting the number of workers exposed. Employers also have to involve, inform and train workers, and consult them on the measures (EUOSHA, 2018a, 2018b, 2019). Personal protection measures, such as the use of personal protective equipment, are only foreseen as a last resort if all the other measures do not protect workers sufficiently. Two directives apply specifically to chemicals and mixtures of dangerous substances, such as process-generated substances. Directive 98/24/EC addresses workplace risks related to chemical agents at work and sets out employers’ obligations (including, for instance, health surveillance). Directive 2004/37/EC on the protection of workers from the risks related to exposure to carcinogenic, mutagenic or reprotoxic (CMR) substances at work has been amended several times from 2017 until 2022 to expand its scope and reduce the risk to workers from CMR substances. Indicative occupational limit values have also been set and are continuously revised, with specific provisions addressing asbestos exposure. Member States must implement these minimum regulations in national legislation and may go beyond the provisions or produce more detailed regulations. A Europe-wide Healthy Workplaces campaign raised awareness of these risks in 2018/19; support is provided to enterprises through risk assessment tools, focused either by risk or sector, as well as access to national guidance and tools. A number of other directives apply to physical factors such as noise, or set requirements for workplaces, equipment or specialised workplaces such as construction sites.

In addition to regulatory and policy action, the EU funds a variety of research and development projects and activities geared towards minimising the effects of toxic chemicals on health and the environment. Because of the novel insights they provide on actual human exposure to chemicals, human biomonitoring initiatives are particularly noteworthy. These include the Human biomonitoring for Europe HBM4EU initiative (2016-2022) and the Partnership for the assessment of risks from chemicals (PARC).


[1] Except Kosovo under UNSCR 1244/99 and Liechtenstein.


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