Nutritional Countermeasures to Environmental Endocrine Disruption in Cardiovascular Disease

Background: Patients remain at substantial residual cardiovascular risk despite standardized management of classical risk factors. These limitations in clinical practice have led to an exposome-based approach. Among environmental exposures, endocrine-disrupting chemicals (EDCs) have emerged as ubiquitous and insidious promoters of cardiometabolic disease. Objectives: This review critically examines chronic environmental exposure to EDCs and the role of these chemicals in cardiovascular injury. In addition, this review highlights how targeted dietary therapies can shift patient management from passive environmental avoidance toward active biological protections. Methods and Results: We review recent mechanistic advances and show that lipophilic EDCs can hijack host signaling networks even at very low exposure levels. These molecular alterations promote mitochondrial dysfunction and global epigenetic reprogramming, leading to proximal metabolic derangements, particularly adipose tissue inflammation, insulin resistance, and atherogenic dyslipidemia. The cardioprotective effects of dietary antioxidants and bioactive phytochemicals appear to arise from intracellular signaling crosstalk. These compounds activate the nuclear factor erythroid 2-related factor 2 (Nrf2) antioxidant pathway while inhibiting the nuclear factor kappa B (NF-κB) proinflammatory cascade, thereby reducing oxidative stress and endothelial inflammation. Bioactive compounds such as polyphenols, omega-3 fatty acids, and vitamin D may function as nutriepigenetic modulators that counter receptor toxicity and resolve vascular inflammation. Simultaneously, the gut microbiota–vascular axis may act as a biological filter. The Mediterranean diet provides one such holistic intervention by strengthening intestinal barrier function, improving short-chain fatty acid (SCFA) signaling, and reducing pro-atherogenic trimethylamine N-oxide (TMAO) production. Conclusions: EDC exposure disrupts metabolism and can lead to cardiovascular disease. Nutritional approaches targeting the vulnerable human–environment interface can become a proactive chemopreventive shield. Future preventive cardiology may require a significant shift toward precision dietary fortification with an exposome-level risk assessment.