Exposure to Volatile Organic Compounds and Cardiovascular Diseases: A Systematic Review and Meta-Analysis

Clinical Snapshot

Key Findings

• P Value: Not statistically significant for random-effects analyses

• Effect Size: VOC mixtures OR 1.57; Benzene-CVD death meta-RR 1.09

• Primary Outcome: Cardiovascular disease incidence and mortality associated with VOC exposure

• Nnt Or Sensitivity: Fixed-effect analyses showed significant positive associations, but inappropriate given high heterogeneity

• Confidence Interval: VOC mixtures 95% CI 0.79-3.11; Benzene 95% CI 0.99-1.21

Clinical Application

Limited clinical utility due to imprecise estimates and high heterogeneity between studies Relevant to Australian urban populations and industrial workers; may inform environmental health policy and occupational exposure limits under Safe Work Australia guidelines General population with ambient VOC exposure, particularly in urban and industrial areas

Abstract

BACKGROUND: Environmental pollution is an often-neglected contributor to cardiovascular disease (CVD). Volatile organic compounds (VOCs) are a subset of ubiquitous pollutants. Recent evidence has suggested exposure to VOCs as a possible contributor to CVD. We aimed to review the evidence for such a link between VOC exposure and cardiovascular outcomes. METHODS: PubMed, Web of Science, and Scopus were systematically searched for ecological and observational studies evaluating associations between exposure to VOCs and cardiovascular outcomes. The available evidence was synthesized qualitatively, and meta-analyses were conducted wherever multiple estimates were identified for a shared association. Sensitivity analyses were performed to evaluate the influence of individual studies on the pooled estimates. RESULTS: Thirty-six studies were included in the review. Pooled random-effects estimates for associations between VOC mixtures (odds ratio, 1.57 [95% CI, 0.79-3.11])/toluene, ethylbenzene, and xylene and CVD trended toward a positive effect while being imprecise. The pooled estimate for the association between exposure to benzene and CVD death also trended toward a positive effect (meta relative risk, 1.09 [95% CI, 0.99-1.21]; I2=91.4 [95% prediction interval, 0.82-1.46]). However, serious inconsistencies were noted on the significance and the magnitude of association. Fixed-effect analyses indicated significant positive effects in all evaluated associations. CONCLUSIONS: Evidence from studies evaluating ambient and individual VOC exposures suggests a possible association with increased CVD and CVD death. However, the heterogeneity noted between specific VOCs' effects, possible confounding, limited long-term exposure assessment, and sparse evaluation of mixture/copollutant effects warrant cautious interpretation of these findings and highlight the need for future high-quality prospective studies.

References

1. 1.Goodarzi, S., Fakouri, M., Shahir-Roudi, E., Naimi-Joubani, M., Djalalinia, S., Pourabbas, R., Dehghannayeri, A., Mahdavi-Gorabi, A., Semnani, K., Esmaeili, S., & Qorbani, M. (2026). Exposure to Volatile Organic Compounds and Cardiovascular Diseases: A Systematic Review and Meta-Analysis. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.047372