Micro-nanoplastics in carotid atheromas: Dioxins and Toxoplasma gondii are an additional matter of concern!

The higher risk of a composite end point of myocardial infarction, stroke, or death among patients carrying micro-nanoplastics (MNPs) in carotid artery plaques, compared with subjects showing no evidence of MNPs in the aforementioned atheromatous lesions, is of relevant concern (1).

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Nevertheless, alongside the objective limitations of this study, the authors correctly state it does not prove causality, provided that a composite of cardiovascular disease (CVD) or death outcomes could be alternatively explained by the potential exposure to other noxae throughout the patient's life (1). Within this challenging context, which could also benefit from the use of "ad hoc" animal models (2), I wonder if the investigators took into adequate account the proven capability of MNPs to act as powerful "attractors and concentrators" for several environmentally persistent pollutants including dioxins and for a number of microbial pathogens like Toxoplasma gondii (3). As a matter of fact, while dioxin exposure has been linked to CVD mortality (4), T. gondii infection may be also associated with myocarditis, constrictive pericarditis, pericardial effusion, arrhythmias (both atrial and ventricular) and congestive/acute heart failure (5).
As a concluding remark, an integrated, multidisciplinary, holistic and One Health-based approach would be highly recommendable when dealing with the human and animal health effects of MNPs, thereby taking into adequate account their exceedingly growing contamination of global land, sea and ocean ecosystems.


1) Marfella, R., et al. (2024). Microplastics and nanoplastics in atheromas and cardiovascular events. N. Engl. J. Med. 390: 900-910.
DOI: 10.1056/NEJMoa2309822.

2) Getz, G.S., Reardon, C.A. (2012). Animal models of atherosclerosis. Arterioscler. Thromb. Vasc. Biol. 32: 1104-1115.
DOI: 10.1161/ATVBAHA.111.237693.

3) Di Guardo, G. (2023). Flood-associated, land-to-sea pathogens' transfer: A One Health perspective. Pathogens 12(11): 1348.
DOI: 10.3390/pathogens12111348.

4) Humblet, O., Birnbaum, L., Rimm, E., Mittleman, M.A., Hauser, R. (2008). Dioxins and cardiovascular disease mortality. Environ. Health Perspect. 116: 1443-1448.
DOI: 10.1289/ehp.11579.

5) Alvarado-Esquivel, C., et al. (2016). Association between Toxoplasma gondii exposure and heart disease: A case-control study. J. Clin. Med. Res. 8: 402-409.
DOI: 10.14740/jocmr2525w.

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