Association Between Exposure to Selected Endocrine-Disrupting Chemicals and Subclinical Carotid Atherosclerosis: A Systematic Review and Meta-Analysis Publisher Pubmed



Assempoor R ; Abroy AS ; Yunesian M
Source: Environmental Research Published:2026

Abstract

Background: Atherosclerosis is a leading cause of death worldwide. Epidemiological studies suggest that exposure to environmental endocrine-disrupting chemicals (EDCs) may be linked to carotid atherosclerosis, but findings are inconsistent and have not been systematically summarized. This study aimed to clarify the association between EDC exposure and carotid atherosclerosis. Methods: We searched PubMed, Web of Science, and Scopus from inception to November 23, 2024, for observational studies assessing the relationship between EDC exposure and carotid intima-media thickness (CIMT) or carotid plaque. The converted effect sizes were synthesized using random effects meta-analysis models. Methodological quality, heterogeneity, and publication bias were evaluated using the Newcastle–Ottawa scale, I2 statistics, Begg's test, and Egger's test. Results: Thirty-six studies were included in this meta-analysis. The pooled-estimate effect sizes showed that population exposure to phthalates (OR: 2.27, 95 % CI: 1.05 to 4.93), perfluoroalkyl substances (MD: 3.49, 95 % CI: 1.05 to 5.93), persistent organic pollutants (MD: 2.43, 95 % CI: 1.45 to 3.41), cadmium (MD: 7.25, 95 % CI: 1.09 to 13.42), and mercury (MD: 4.63, 95 % CI: 0.02 to 9.25) were positively correlated with CIMT. On the other hand, exposure to persistent organic pollutants (OR: 1.10, 95 % CI: 1.06 to 1.14) and arsenic (OR: 1.46, 95 % CI: 1.11 to 1.94) increased the risk of carotid plaque. Conclusion: This study revealed that EDCs were potential risk indicators for carotid atherosclerosis. Nonetheless, the sensitivity analysis results of some of the meta-analyses were not stable and demonstrated high heterogeneity. The evidence for these associations is limited, and more large-scale population-based and longitudinal studies are required to confirm these findings. © 2025 Elsevier Inc.