Exposure to Volatile Organic Compounds and Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Environmental pollution is an often-neglected contributor to cardiovascular disease (CVD). Volatile organic compounds (VOCs) are a subset of ubiquitous pollutants. Recent evidence has suggested exposure to VOCs as a possible contributor to CVD. We aimed to review the evidence for such a link between VOC exposure and cardiovascular outcomes.

PubMed, Web of Science, and Scopus were systematically searched for ecological and observational studies evaluating associations between exposure to VOCs and cardiovascular outcomes. The available evidence was synthesized qualitatively, and meta-analyses were conducted wherever multiple estimates were identified for a shared association. Sensitivity analyses were performed to evaluate the influence of individual studies on the pooled estimates.

Thirty-six studies were included in the review. Pooled random-effects estimates for associations between VOC mixtures (odds ratio, 1.57 [95% CI, 0.79-3.11])/toluene, ethylbenzene, and xylene and CVD trended toward a positive effect while being imprecise. The pooled estimate for the association between exposure to benzene and CVD death also trended toward a positive effect (meta relative risk, 1.09 [95% CI, 0.99-1.21]; I²=91.4 [95% prediction interval, 0.82-1.46]). However, serious inconsistencies were noted on the significance and the magnitude of association. Fixed-effect analyses indicated significant positive effects in all evaluated associations.

Evidence from studies evaluating ambient and individual VOC exposures suggests a possible association with increased CVD and CVD death. However, the heterogeneity noted between specific VOCs' effects, possible confounding, limited long-term exposure assessment, and sparse evaluation of mixture/copollutant effects warrant cautious interpretation of these findings and highlight the need for future high-quality prospective studies.