Can exposure to airborne hazards and open burn pit compounds, including benzene, toluene, m-xylene, p-xylene, iron, naphthalene, o-xylene, vanadium, particulates not otherwise specified (PNS), and ethyl benzene, cause Peripheral Vascular Disease (PVD)?

Exposure to Burn Pit Compounds and Risk of Peripheral Vascular Disease

Exposure to airborne hazards and open burn pit compounds, including benzene, toluene, xylenes, and other toxic chemicals, can contribute to the development of peripheral vascular disease (PVD) through mechanisms of oxidative stress, endothelial dysfunction, and systemic inflammation.

Relationship Between Chemical Exposures and Vascular Disease

Evidence for Causation

• The American College of Cardiology and American Heart Association recognize environmental and occupational chemical exposures as modifiable cardiovascular risk factors 1
• Chemical exposures from burn pits can cause systemic inflammation and oxidative stress that contribute to endothelial dysfunction, a key mechanism in the development of PVD 1
• Particulate matter (PM) exposure has been associated with cardiovascular outcomes, with an incremental 10 μg/m³ of PM2.5 linked to increased cardiovascular mortality (RR 1.15; 95% CI 1.04,1.27) 2

Specific Burn Pit Compounds and Vascular Effects

• Benzene, toluene, xylenes, and other volatile organic compounds (VOCs) found in burn pit emissions are known to cause vascular inflammation and oxidative damage 1, 3
• Polycyclic aromatic hydrocarbons (PAHs) in burn pit smoke, particularly from burning plastics at high temperatures, demonstrate significant toxicity and inflammatory effects 3
• Particulate matter from burn pits is predominantly less than 2.5 μm in diameter, which can penetrate deeply into the lungs and potentially enter the bloodstream 3

Military-Specific Evidence

Burn Pit Registry Findings

• The Airborne Hazards and Open Burn Pit Registry has shown dose-response associations between burn pit exposure and respiratory conditions 4
• A study examining burn pit exposure in Balad, Iraq found a slight increased risk for cardiovascular disease (adjusted RR: 1.072), though not statistically significant 5

Mechanisms of Vascular Injury

• Burn pit smoke contains fine particulates that can trigger systemic inflammation, oxidative stress, and endothelial dysfunction 3
• Plastic-containing waste burned at high temperatures produces emissions with greater inflammatory and lung injury potential, which may contribute to systemic vascular effects 3

Risk Factors and Susceptibility

Enhanced Risk with Co-exposures

• Hypertension commonly co-occurs with PVD (35-55% of PVD patients also have hypertension), and the combination significantly increases cardiovascular risk 6
• Individuals with pre-existing conditions or genetic susceptibility may be more vulnerable to chemical-induced vascular damage 1
• Older individuals (>65 years) show greater blood pressure increases with chemical exposures, potentially increasing PVD risk 1

Duration and Intensity of Exposure

• Significant dose-response relationships have been observed between days of deployment near burn pits and respiratory conditions, suggesting similar relationships may exist for vascular outcomes 4
• Chronic exposure to airborne toxins contributes to the development and progression of atherosclerosis, a key component of PVD 1

Prevention and Management Considerations

Monitoring and Screening

• Healthcare providers should incorporate exposure assessment into cardiovascular disease management for veterans with burn pit exposure history 1
• Regular vascular screening is recommended for those with significant burn pit exposure history 1

Protective Measures

• Personal protective equipment, particularly respiratory protection, can reduce risk during exposure periods 1
• Environmental modifications and air filtration in workplaces and residences can reduce ongoing exposures 1

Conclusion

While direct evidence specifically linking burn pit exposure to PVD is still emerging, the established pathophysiological mechanisms of vascular injury from similar chemical exposures strongly suggest a causal relationship. The components in burn pit emissions, particularly benzene, toluene, xylenes, PAHs, and fine particulate matter, are known to cause endothelial dysfunction, oxidative stress, and systemic inflammation—all key mechanisms in the development of peripheral vascular disease. Veterans with significant burn pit exposure should be monitored for early signs of vascular disease and receive appropriate preventive interventions.