Chemicals

Chemicals and cardiovascular disease

Exposure to some of the chemicals present in European workplaces and/or released to the environment contribute to the cardiovascular disease burden. This can come either from direct exposure to chemicals at the workplace or through the products that we use, or through indirect exposure to chemicals that are released to the environment and enter our drinking water, food or air. These chemicals come in many forms and include heavy metals, organic solvents and chemical air pollutants like polycyclic aromatic hydrocarbons (PAHs), Benzene, PFAS and pesticides (Rovira et al., 2020; Meneguzzi et al., 2021). Many of these chemicals have other toxic effects, contributing to other illnesses such as cancer or respiratory diseases. In some cases they have already been found in potentially risky concentrations in samples from the general population, in the context of the European human biomonitoring initiative (HBM4EU, 2022). Box 2 highlights selected chemicals with known cardiovascular effects.

Because of the enormous diversity of chemicals and exposures, and a lack of data, we are not certain about the overall contribution of chemicals to the burden of cardiovascular disease in European residents. Relatively few of the thousands of substances in our surroundings have been examined in epidemiological studies for their potential links to CVD. Furthermore, the existing tests that are normally required under the relevant chemical regulations (e.g. REACH, the Biocide Regulation, the Plant Protection Product Regulation, etc.) have very limited sensitivity to detect substances that can affect the cardiovascular system (Daley et al., 2023). This means that many chemicals on the market and in the environment have not undergone exhaustive toxicity testing, and significant knowledge gaps remain on the potential cardiovascular effects of low levels of exposure to combinations of chemicals throughout our lifetime.

Trends in exposure to chemicals in Europe

85% of European residents say they are worried about the impact of chemicals on their health (Directorate-General for Communication, 2020). In 2020, over 208 million tonnes of chemicals harmful to health were produced in the EU; this amount has not decreased significantly since 2004 (EUROSTAT, 2022; Persson et al., 2022). Moreover, some of the efforts to replace dangerous chemicals may have resulted in regrettable substitutions — when one chemical is used to replace another problematic one but turns out to be hazardous, too (Maertens et al., 2021). Exposure to toxic chemicals comes from multiple sources and pathways, including outdoor and indoor air pollution, smoking (either directly or second-hand), consumer products, drinking water and food, and in relation to different occupations. In a recent European Working Conditions Survey (Eurofound, 2021), over 21% of EU workers reported being often or always exposed to chemical products or substances. Many common toxic workplace chemicals are generated when carrying out specific tasks or applying specific technologies (cutting stone, grinding or cutting wood, welding, processing metal products, combustion, etc.) rather than substances that are marketed or used as such. For these and other workplace toxic chemicals, exposure is mainly reduced through prevention measures such as local exhaust ventilation.

What the EU is doing about toxic chemicals

The EU has a wide variety of policies, mechanisms and bodies intended to address the risks associated with chemicals in products and chemical mixtures. The EU chemicals strategy for sustainability aims to protect people and the environment from toxic chemicals. The recently published Restrictions Roadmap, meanwhile, aims to ensure implementation, which would in turn result in the largest regulatory restriction exercise ever seen for toxic chemicals.

The Regulation on the registration, evaluation, authorisation and restriction of chemicals (REACH Regulation) aims to better protect human health and the environment from the risks posed by chemicals. Under the REACH Regulation, companies manufacturing and marketing hazardous substances in the EU must demonstrate to the European Chemicals Agency (ECHA) how the substance can be safely used and provide risk management measures for users. Under the chemicals strategy for sustainability, the European Commission proposes a more integrated approach to chemical risk assessment. This especially applies to chemicals with similar hazards, risks or functions.

The European Food Safety Authority (EFSA) routinely carries out risk assessments on a wide range of substances in the food chain. The Farm to Fork strategy, for its part, intends to address the challenges of sustainability in food systems, including reducing the risks to human health and the environment from exposure to chemical pesticides and substances used in food manufacturing.

A comprehensive legislative framework sets out employers’ responsibility for the health and safety of workers. Employers must carry out a workplace risk assessment, and implement protective and preventive measures, following a hierarchy of prevention. This hierarchy first prioritises eliminating toxic chemicals, then substituting toxic chemicals with less hazardous substances, and finally where neither is possible, applying collective prevention measures such as using local exhaust ventilation or limiting the number of workers exposed. Employers also have to involve, inform and train workers, and consult them on the measures (EUOSHA, 2018a, 2018b, 2019). Personal protection measures, such as the use of personal protective equipment, are only foreseen as a last resort if all the other measures do not protect workers sufficiently. Two directives apply specifically to chemicals and mixtures of dangerous substances, such as process-generated substances. Directive 98/24/EC addresses workplace risks related to chemical agents at work and sets out employers’ obligations (including, for instance, health surveillance). Directive 2004/37/EC on the protection of workers from the risks related to exposure to carcinogenic, mutagenic or reprotoxic (CMR) substances at work has been amended several times from 2017 until 2022 to expand its scope and reduce the risk to workers from CMR substances. Indicative occupational limit values have also been set and are continuously revised, with specific provisions addressing asbestos exposure. Member States must implement these minimum regulations in national legislation and may go beyond the provisions or produce more detailed regulations. A Europe-wide Healthy Workplaces campaign raised awareness of these risks in 2018/19; support is provided to enterprises through risk assessment tools, focused either by risk or sector, as well as access to national guidance and tools. A number of other directives apply to physical factors such as noise, or set requirements for workplaces, equipment or specialised workplaces such as construction sites.

In addition to regulatory and policy action, the EU funds a variety of research and development projects and activities geared towards minimising the effects of toxic chemicals on health and the environment. Because of the novel insights they provide on actual human exposure to chemicals, human biomonitoring initiatives are particularly noteworthy. These include the Human biomonitoring for Europe HBM4EU initiative (2016-2022) and the Partnership for the assessment of risks from chemicals (PARC).