Cardiovascular Health Risks of Organophosphate Flame Retardant Exposure: A Narrative Review of the Available Evidence

Organophosphate ester flame retardants (OPFRs) have emerged as ubiquitous environmental contaminants following regulatory restrictions on brominated flame retardants. Despite widespread human exposure across global populations, cardiovascular health implications remain incompletely characterized. This Review summarizes current evidence regarding OPFR exposure and cardiovascular health risks, identifying biological mechanisms and vulnerable populations requiring enhanced protection. A systematic literature search in PubMed (January 2015-June 2025) identified 108 relevant publications encompassing epidemiological studies, experimental investigations, and mechanistic research. Due to substantial methodological heterogeneity across study designs, a narrative review was employed rather than a quantitative meta-analysis. Robust epidemiological evidence demonstrates significant associations between OPFR exposure and cardiovascular morbidity across multiple populations. Cardiovascular disease risk assessment revealed a positive association between OPFRs and cardiovascular disease (OR = 1.25, 95% CI: 1.02-1.53). Three principal mechanisms underlie OPFRs' cardiovascular toxicity, including oxidative stress cascades, endothelial dysfunction through nitric oxide pathway interference, and endocrine-metabolic disruption via liver X receptor antagonism. Vulnerable populations include pregnant women, children, and occupationally exposed groups demonstrating heightened cardiovascular risks. Compelling evidence supports significant associations between OPFR exposure and elevated cardiovascular disease risk through multiple biological pathways. Future research priorities include long-term prospective studies, mixture toxicology investigations, and standardized exposure assessment protocols.