Endocrine-Disrupting Chemicals and Human Cardiometabolic Health: A Scoping Review

Abstract: Background: Endocrine-disrupting chemicals (EDCs) can interfere with hormonal and metabolic pathways relevant to cardiometabolic health. Human evidence has expanded but remains dispersed across outcomes. Objectives: To map human epidemiological evidence associating EDC exposure with cardiovascular diseases (CVDs), metabolic syndrome (MetS), and metabolic dysfunction-associated steatotic liver disease (MASLD). Methods: We searched EMBASE and Web of Science from inception to 14 July 2025, updating EMBASE search on 31 July 2026. Eligible studies quantitatively evaluated associations between EDC exposure and CVDs, MetS, or MASLD in humans. Findings were synthesised descriptively. Results: We included 93 unique studies: 42 on CVDs, 36 on MetS, and 19 on MASLD. Over half were published within the last five years. Phenols and phthalates were the most frequently investigated classes. Bisphenol A was associated with several CVDs although findings for hypertension and vascular markers were mixed. Phthalate metabolites showed associations with cardiovascular and hepatic outcomes. Prospective studies reported earlier MetS onset with selected per- and polyfluoroalkyl substances and incident MASLD with selected polychlorinated biphenyls. Studies predominantly involved adults, cross-sectional designs, and single exposure measurements. Conclusions: Human epidemiological research on EDCs and cardiometabolic health is expanding, with strongest evidence for associations with Bisphenol A and some phthalates. The reported associations were heterogeneous, and studies were concentrated in North America, Europe, and Asia, with limited representation from other geographical regions. Future research should prioritise prospective designs, repeated exposure assessment, chemical mixtures, clinically relevant outcomes, and greater geographical representation to strengthen future health and regulatory assessments of EDC-related cardiometabolic risks.