Microplastics and Nanoplastics as a Novel Cardiovascular Risk Factor: A Narrative Review

Microplastics and nanoplastics (MNPs) are pervasive environmental contaminants now detected throughout the human cardiovascular system, including atherosclerotic plaques, coronary and carotid arteries, cardiac tissue, peripheral blood, and vascular thrombi. Against the backdrop of cardiovascular disease (CVD) accounting for approximately 17-20 million deaths annually, MNPs have emerged as a candidate modifiable cardiovascular risk factor. In the landmark prospective cohort by Marfella and colleagues (N Engl J Med 2024), MNP-laden carotid plaques conferred a 4.53-fold increased risk of major adverse cardiovascular events (MACE). MNPs were also detected in 80% of human thrombi from patients with myocardial infarction (MI), stroke, and deep vein thrombosis (DVT). Experimental studies link MNPs to cardiovascular toxicity through oxidative stress, NF-κB-mediated inflammation, endothelial senescence and dysfunction, macrophage foam cell formation, and Wnt/β-catenin-mediated cardiac fibrosis. This narrative review synthesizes current evidence linking MNPs to coronary artery disease, myocardial infarction, arrhythmias, heart failure, and thrombosis, and evaluates clinical and public health implications. Standardized detection protocols, large-scale prospective studies, and regulatory action are urgently warranted.