Micro-nanoplastics in Cardiovascular Disease: A Critical Update from Environmental Exposure to Clinical Implications

Micro- and nanoplastics (MNPs) are emerging environmental contaminants that may contribute to cardiovascular risk. Observational human studies have reported the presence of MNPs in patients with myocardial infarctions, acute coronary syndrome, coronary artery disease, extracranial artery stenosis, and asymptomatic extracranial internal carotid artery stenosis, where higher MNP levels have been associated with inflammatory and coagulation-related biomarkers and disease severity. Moreover, experimental in vivo and in vitro studies provide biological plausibility for these associations by showing that MNP exposure may promote endothelial dysfunction, oxidative stress, inflammation, platelet activation, coagulation abnormalities, cardiometabolic alterations, myocardial remodeling, fibrosis, and hypertension. However, major uncertainties remain regarding environmentally relevant exposure levels, long-term human effects, and the translational relevance of current experimental findings. This review critically summarizes the current evidence on the potential cardiovascular effects of MNPs, focusing mainly on endothelial dysfunction, platelet activation, the coagulation cascade, inflammation, gut dysbiosis, and alterations in lipid metabolism. We also discuss emerging therapeutic perspectives, iatrogenic exposure through cardiovascular medical devices, and the major methodological and translational limitations that currently hinder definitive cardiovascular risk assessment in humans.