Phthalates may be associated with an increased risk of cardiometabolic diseases by interfering with glucose and lipid metabolism and by promoting adipogenesis. This study aimed to perform a systematic review and meta-analysis of the association between phthalate exposure and subclinical carotid atherosclerosis, using surrogate markers such as carotid intima-media thickness (IMT) and carotid plaques. The literature search was performed using four databases (Web of Science, Medline, PubMed, and Scopus), and this systematic review includes all available observational studies until July 6th, 2023. The Joanna Briggs Institute critical appraisal tool was used to assess the risk of bias. Meta-analyses were performed, and random effects models were used. Six high-quality cross-sectional studies and 2570 participants aged 12 to 70 were included. Six phthalate metabolites showed significant associations with subclinical carotid atherosclerosis. Exposure to MBzP, ΣDEHP, and MnBP was associated with increased carotid IMT. Exposure to MEP was associated with a higher prevalence of carotid plaques, and MiBP was associated with a lower prevalence. Mixed results were observed for MMP in older adults. The meta-analyses showed a high degree of heterogeneity, and the results are based on single studies. This study accurately describes the evidence of this association to date, suggesting that phthalates are associated with increased carotid IMT and a higher prevalence of carotid plaques. Further research is needed to elucidate this association, as phthalates are still used in the manufacture of everyday products, humans continue to be exposed to them, and atherosclerosis is a public health concern.

中文翻译：

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邻苯二甲酸盐暴露与亚临床颈动脉粥样硬化：系统评价和荟萃分析


邻苯二甲酸盐可能通过干扰葡萄糖和脂质代谢以及促进脂肪生成而增加心脏代谢疾病的风险。本研究旨在使用颈动脉内膜中层厚度（IMT）和颈动脉斑块等替代标志物，对邻苯二甲酸盐暴露与亚临床颈动脉粥样硬化之间的关联进行系统回顾和荟萃分析。使用四个数据库（Web of Science、Medline、PubMed 和 Scopus）进行文献检索，该系统综述包括截至 2023 年 7 月 6 日的所有可用观察性研究。乔安娜·布里格斯研究所 (Joanna Briggs Institute) 关键评估工具用于评估以下风险：偏见。进行荟萃分析，并使用随机效应模型。纳入了六项高质量的横断面研究和 2570 名 12 至 70 岁的参与者。六种邻苯二甲酸酯代谢物与亚临床颈动脉粥样硬化显着相关。暴露于 MBzP、ΣDEHP 和 MnBP 与颈动脉 IMT 增加相关。暴露于 MEP 与颈动脉斑块的患病率较高相关，而 MiBP 则与较低的患病率相关。在老年人中观察到 MMP 的结果不一。荟萃分析显示出高度的异质性，并且结果基于单一研究。这项研究准确地描述了迄今为止这种关联的证据，表明邻苯二甲酸盐与颈动脉 IMT 增加和颈动脉斑块患病率较高有关。需要进一步的研究来阐明这种关联，因为邻苯二甲酸盐仍在日常产品的制造中使用，人类继续接触它们，而动脉粥样硬化是一个公共健康问题。