Doctor’s Insights: What do Microplastics Mean for Heart Health?
We find plastics everywhere. It's hard to imagine life without them. But what about microplastics?
Microplastics are tiny pieces of plastic that break down from larger plastics or synthetic materials found in many of the products we use today.
We're still learning what these tiny plastics may mean for our health, including whether they affect our heart health.
Michael Brener, MD, an interventional cardiologist, and Isaac George, MD, a cardiac surgeon, at Columbia, have teamed up with researchers at the Columbia Lamont-Doherty Earth Observatory to explore how these microplastics make their way into the human heart and how they could be influencing the way heart valves function.
We spoke with them to get their perspective on what we know so far, what we don’t know, and what questions they are working on to answer.
The research on microplastics and cardiovascular disease has generated a lot of headlines. As physicians and researchers, what do you think the public is getting right and wrong about these findings?
Michael Brener, MD: We have some evidence linking microplastics with heart-related problems in patients who already have heart disease. A recent study [in the European Heart Journal] looked at people's hearts and arteries and found evidence of these small microplastics inside the arteries. People who had more microplastics also seemed to have more heart-related problems.
Most of the research so far has focused on plaque buildup in the arteries. There are many other types of heart disease that we still need to study, including diseases of the heart muscle and heart valves.. We don't want people to see headlines about microplastics and immediately worry that they're going to have a heart attack. We simply don't have the evidence to say that.
Isaac George, MD: I think there is still fundamentally so much we don’t know. Headlines like “plastics in the heart” can be sensational, so it’s our job to educate the public based on science.
There is no question that if we find plastics have a role in heart disease that is more than incidental, it will have large implications. As of now, I don’t think we have to change our behavior, but we should try to make small changes in lifestyle to try to avoid excess exposure.
When you read the emerging evidence linking microplastics to atherosclerosis and cardiovascular events, what concerns you most as a cardiologist and a cardiac surgeon?
Michael Brener, MD: The biggest concern is that cardiovascular disease is still a major health problem, and all the factors of heart disease are still not well understood.
I think the interesting component is that as we learned to understand the different forms of heart disease, not much attention was made to microplastics and nanoplastics at the time. Now we know these particles are all around us, and we don't yet understand how they may affect the heart and blood vessels.
What we’re concerned about is that these plastics embed within human tissue, and then they incite or initiate an inflammatory reaction. Kind of like when you get a cold, that same inflammatory process that makes you sick. Does that sort of process happen inside the heart, inside the arteries? And then does it impair overall function of the cardiovascular system? We don't know that yet and I think that's a really, really important message and a take-home point for the public.
That’s why we need more research. We need studies that are really focused on this to better understand the risk and only then can we give patients and the public better guidance at large.
Isaac George, MD: We really need to generate scientific and causal data that links plastics to [heart] disease. I think what concerns me is: 1) the cost of what will be needed to change plastic exposure, and 2) how to go about that? It's monumental, changing almost everything in our everyday and medical life.
We will need to establish thresholds, anatomic and physiologic interactions that are meaningful and not meaningful and then prioritize. The good news is that I have a lot of faith in materials science. I believe they will find healthier alternatives or better formulations that could make this problem irrelevant.
If a patient walked into your office tomorrow and asked, "Should I be worried about microplastics affecting my heart?", how would you answer them today?
Michael Brener, MD: I would frame it in the context of all the traditional things we already know about the important risk factors that contribute to heart disease. You should be much more focused on things like eating a healthy diet, exercising, managing your cholesterol and blood pressure, and not smoking.
We need to put everything into context here: I don't want patients to think avoiding or decreasing microplastic exposure is somehow a treatment in and of itself. We don't have enough information to tell patients that they need to dramatically change their lives to avoid microplastics. There is enough evidence to tell us that we need to study the issue more, but not enough to say that avoiding plastic should replace proven treatments that we know save lives.
At the same time, I don't think we should assume that all plastics are the same. There may be certain types of plastics that are more important than others. With more research, we may be able to identify those and develop better ways to reduce exposure.
Isaac George, MD: I would say yes and no. We are always concerned and we should try to avoid excess exposure. But we don’t know how much this is a problem, and how microplastics affect the body.
Has this research changed any of your own habits or the way you think about everyday exposures to microplastics?
Michael Brener, MD: I’m generally conscious of my plastic exposure. I try not to bathe everything in plastic, and I would honestly say I did that before I even started researching this topic. Out of other scientific recognition, we know that microplastics are in the water and in things that we eat. There's a lot more attention, a lot more research looking at the interaction between plastics and GI health and things like that. So, there is research out there and many reasons to avoid microplastics. But when it comes specifically to heart health, the research isn't far enough along for me to say that we should dramatically change our behavior.
Isaac George, MD: In general, I think we should try to live healthy and keep major lifestyle risk factors such as weight loss, cholesterol management and smoking reduction, etc. as our main focus.
Secondary things such as plastics prevention are important but it hasn’t changed my life too much. The one thing that I try to do is not drink water from plastic bottles or take liquids from hot plastic bottles. Finally, I think cheap plastic may be different than higher grades but that also remains to be proven.
Looking ahead 10 years, do you think we will view microplastics as a major cardiovascular risk factor, or do you think the story will turn out to be more complicated than that? Why?
Michael Brener, MD: The work that Isaac and I are doing has a lot of potential. For example, bioprosthetic valves are surgical transcatheter valves that we put in the heart. Sometimes these valves don’t last and the mechanisms by which these valves fail is not fully understood yet. I believe we have the potential to really create a breakthrough in understanding bioprosthetic valve dysfunction [when the valve fails].
We're very lucky to partner with the Columbia Lamont-Doherty Earth Observatory. The research teams develop ways of identifying microplastics - whether they're present in human heart valve tissue. From there, we can ascertain how often they're present, how much of them are present, and whether they contribute in some way to abnormal valve function.
If microplastics play a role in the deterioration of these valves, that could help us understand why they fail and potentially find ways to prevent it. It could even help us design replacement valves that are more resistant to this type of damage. That's the exciting part of our research, and that may play out over the next 10 years and give us very important directions on how to change our behavior or clinical practice or what we tell patients.
Isaac George, MD: One of the things that we have at Columbia is an amazing data bank. We have a group of researchers who are experts on plastics and plastics signaling and interactions with human tissues. So, time will tell. I will hopefully be retired by then, sipping a drink on the beach from a plastic cup.
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