Pyrethroid-induced cardiac Dysfunction: A systematic review and meta-analysis of preclinical evidence

Pyrethroids are synthetic insecticides widely applied in agriculture and domestic settings, but emerging evidence indicates adverse cardiovascular effects. This systematic review and meta-analysis assessed the impact of pyrethroid exposure on cardiac electrophysiology and secondary pathways including inflammation, oxidative stress, and myocardial injury. Literature searches in PubMed, Embase, and Web of Science up to July 2025 identified 25,884 records, of which 18 studies met the inclusion criteria (15 included in meta-analysis). Pooled analyses demonstrated significant prolongation of action potential duration (APD90), QT interval, and impaired force of contraction. Biomarkers of myocardial injury (troponin I, CK-MB) were consistently elevated. Pro-inflammatory mediators (IL-1β, IL-6, TNF-α) and NF-κB activity were upregulated, whereas antioxidant components (SOD, CAT, GPx, GSH, Nrf2) were reduced, accompanied by increased oxidative stress markers (MDA, NO). Together, these findings indicate that pyrethroids disrupt cardiac electrical stability and induce cytotoxic, inflammatory, and oxidative damage. Although heterogeneity across studies was moderate to high, the evidence consistently supports a multifactorial cardiotoxic profile. These results highlight the need to re-evaluate pyrethroid safety thresholds and to advance mechanistic and translational research into their cardiovascular effects.