India tops global heart deaths — and your shampoo may be to blame

medium120823126In 2018, over 1.03 lakh Indians died of heart disease triggered not by smoking, diet, or high cholesterol — but by exposure to a chemical used in shampoo bottles, cling wrap, and plastic packaging. The figure comes from a landmark global study published this week in eBioMedicine, a journal from The Lancet stable, which lays bare a previously under-recognised killer: di-2-ethylhexyl phthalate (DEHP).This single chemical — used to make plastic flexible and to hold fragrance in cosmetics — was linked to more cardiovascular deaths in India than in any other country.China had 50% more people in the 55-64 age group dying of exposure to DEHP, India recorded 70% more deaths. The numbers are not just staggering. They suggest a quiet public health disaster, decades in the making — and still largely invisible.Across the world, DEHP was responsible for an estimated 356,238 cardiovascular deaths among middle-aged adults in 2018. India alone accounted for nearly 29% of all such deaths in South Asia, and lost 2.9mn years of life — ‘years of life lost’ is a standard global health metric that estimates how many years people would have lived if they hadn’t died prematurely — that year to phthalate-linked heart disease.A poison in your houseYou don’t see DEHP. You don’t smell it. And it won’t appear on the label of your shampoo or moisturiser. But it is almost certainly there. DEHP is used in hundreds of daily-use items — from food storage tubs to IV tubing, hair conditioners to kids’ toys. It leaches into food, gets into the air as indoor dust, and seeps into the skin through cosmetics. Over time, it builds up in our bodies.Once inside, DEHP breaks down into metabolites — chemical products that can interfere with hormones, trigger oxidative stress, and promote inflammation. Together, they increase the risk of obesity, diabetes, atherosclerosis, and ultimately, heart attacks and stroke.Researchers have also found phthalates act as anti-androgens, interfere with genes that regulate fat metabolism, and even accelerate arterial hardening. Some of these effects are now considered similar in severity to exposure to air pollution or heavy metals. medium nocaptionhttps://ip.tgsession.com/3sw658_7hzteqpqoj/1kahL9OCGnT3kB?2qxpm=9nqFWDEZTNkVdDrhd4hBid India is bearing the bruntThe study explains India’s disproportionate toll with a mix of industrial, demographic, and policy factors. South Asia and West Asia had the world’s highest DEHP exposure levels, based on urine biomonitoring from 2008. India’s DEHP exposure was so widespread that researchers found little variation across economic classes — meaning rich and poor alike were equally exposed.The reason: most Indian shampoos, lotions, plastic wraps, and food-grade containers still contain DEHP. There are no mandatory “phthalate-free” labelling requirements, and only weak restrictions exist. While the EU and US phased out DEHP in many products between 2000 and 2015, India introduced partial restrictions for food-contact materials only in 2023. Personal care products remain unregulated.And the exposure shows up in our bodies. DEHP metabolites have been detected in nearly every human population tested. In India’s case, the study noted extremely high weighted average exposures for all four key DEHP byproducts — nearly 6 times higher than the lowest-exposure regions such as Europe.How the study was conductedTo arrive at the global death estimates, researchers used cardiovascular mortality data from the Institute for Health Metrics and Evaluation (IHME), population estimates from the World Bank, and regional exposure levels modelled from a 2008 dataset. A 10-year lag was applied to connect exposure to heart disease outcomes in 2018.Hazard ratios for death were based on urine samples and mortality outcomes from previous epidemiological studies in the US. Where direct data were missing — such as in South Asia — the researchers used meta-analyses and regression modelling to estimate exposure levels. Sensitivity tests showed consistent results even under conservative assumptions.The final results were concerning:13.5% of all heart disease deaths worldwide among people aged 55-64 were linked to DEHP exposure. Of these, 98% were due to DEHP used in plasticsIndia recorded the most deaths: 103,587, compared to 60,937 in ChinaIndia also lost the most years of life — 2.9mn, far ahead of all other nationsGlobally, more than 10.4mn years of life were lost due to DEHP in 2018. But the burden was far from evenly spread. Three-quarters of all deaths occurred in Asia, especially in low- and middle-income countries with rising plastic use and weak regulation. medium120823255India’s case is particularly alarming because DEHP-attributable cardiovascular mortality rates here are among the highest in the world. In South Asia and West Asia, an average 16.8% of all heart disease deaths in the 55-64 age group could be blamed on DEHP — significantly more than in the US (10.4%) or Europe (8.3%).The study’s authors stress that this is not merely a toxicology issue — it is a public health failure. “Plastic-related chemicals significantly contribute to cardiovascular mortality,” they write. “Reducing phthalate exposure through regulation could lead to a significant decrease in deaths.”What we should know about the studyWhile the study offers new global estimates, it is not without limitations. It is an observational model, not a clinical trial. The key hazard ratio used to calculate cardiovascular risk was derived from US data (NHANES), which may not fully reflect global variations in lifestyle, diet, or medical access.Still, the authors built in robust sensitivity analyses. They tested alternative models using WHO life expectancy and different mathematical assumptions. Even in conservative models, DEHP still explained over 13% of cardiovascular deaths globally among the 55-64 age group. In the top 5% exposure percentile, the mortality risk jumped as high as 30%.The scale and rigour of the model — using biomonitoring data from over a dozen global regions and applying IHME mortality rates and World Bank population estimates — make it one of the most comprehensive evaluations of chemical-related CVD risk to date.What needs to be doneWhile banning phthalates across industries will take time and global consensus, there are immediate steps individuals can take:Avoid microwaving food in plastic — especially cling film or disposable containersUse glass, steel, or ceramic containers for hot foodCheck for “phthalate-free” labels on cosmetics and toysAvoid products with vague terms like “fragrance” or “parfum”, which often hide phthalatesVentilate your home regularly, as DEHP can also be airborne in household dustGlobally, the study is expected to influence the UN’s Global Plastics Treaty, still under negotiation. But in India, where DEHP is silently shortening lives every day, the bigger challenge lies in enforcement and public awareness. The invisible threat is now visible — in death tolls, in data, and in decades lost.Research by Rajesh Sharma