Elevated Hydrocarbon Exposure Escalates Coronary and Cerebrovascular Disease Risks: A Comprehensive Systematic Review

Exposure to hydrocarbons, including polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs), represents an escalating public health concern. These compounds induce systemic inflammation, oxidative stress, and endothelial dysfunction, driving cardiovascular disease (CVD) pathogenesis. This systematic review evaluates the association between hydrocarbon exposure and CVD risk, focusing on specific metabolite biomarkers. A comprehensive search of PubMed, Embase, and Web of Science was conducted up to June 10, 2025. Observational studies evaluating correlations between hydrocarbon exposure and CVD outcomes-including coronary heart disease (CHD), stroke, and myocardial infarction (MI)-were selected for narrative synthesis. Eleven studies met the inclusion criteria. Included studies were of moderate to high quality with a low overall risk of bias. The PAH metabolites 1-hydroxynaphthalene (6 studies), 2-hydroxynaphthalene (7 studies), 2-hydroxyfluorene (6 studies), 3-hydroxyfluorene (5 studies), and 1-hydroxypyrene (5 studies) were consistently associated with elevated risks of CHD, stroke, and MI. Similarly, exposure to BTEX components (benzene, toluene, ethylbenzene, and xylene) evaluated in one study significantly correlated with heightened CVD incidence. These associations appeared more pronounced in highly exposed populations, particularly occupational cohorts, although effect sizes varied across studies because of study design differences and residual confounding factors such as smoking. Overall, the available evidence suggests an association between hydrocarbon exposure and increased CVD risk. Further prospective longitudinal studies are needed to confirm these findings and clarify the underlying toxicological mechanisms.