Introduction: Organophosphate pesticides (OPs) are widely used globally, raising concerns about their long-term cardiovascular effects. While neurotoxicity is well established, OP-induced cardiotoxicity remains underexplored. This systematic review evaluated current evidence on cardiovascular outcomes, mechanisms, and potential protective interventions related to OP exposure.
Methods: A systematic search of PubMed, Scopus, Web of Science, Embase, and Google Scholar was conducted to identify eligible studies published between January 2014 and October 2024. Following PRISMA 2020 guidelines, randomized trials, observational human studies, animal experiments, and in vitro models examining OP exposure and cardiovascular outcomes were included. Data on exposure type, study design, cardiovascular endpoints, mechanisms of toxicity, protective agents, and study quality were extracted. Risk of bias was assessed using the Newcastle-Ottawa Scale, Cochrane RoB, and SYRCLE tools.
Results: Thirty-eight studies met inclusion criteria, comprising 23 animal studies, 15 human observational studies, and 3 in vitro/in silico studies. OP exposure was associated with various cardiovascular effects, including hypertension, arrhythmias, myocardial infarction, cardiac hypertrophy, QT prolongation, and heart failure. Key mechanisms identified included oxidative stress, mitochondrial dysfunction, calcium signaling disruption, inflammatory activation, and electrophysiological alterations. Several animal studies reported partial cardioprotection from antioxidants and phytochemicals, though human evidence remains limited. Selection bias and inconsistent exposure assessment were common across studies, restricting causal inference.
Conclusion: Available data suggest that OP exposure increases cardiovascular risk via oxidative and inflammatory mechanisms, with experimental evidence for potential protective interventions. More robust longitudinal human studies and intervention trials are needed to clarify causality and guide prevention strategies.