Cardiovascular drugs and lipid regulating agents in surface waters at global scale: Occurrence, ecotoxicity and risk assessment.

Cardiovascular drugs and lipid regulating agents have emerged as major groups of environmental contaminants over the past decades. However, knowledge about their occurrence in freshwaters and their ecotoxicity is still limited. Here, we critically summarize the presence of 82 cardiovascular drugs and lipid regulating agents at a global-scale and represent their effects on aquatic organisms. Only about 71% of these pharmaceuticals in use have been analyzed for their residues in aquatic ecosystems and only about 24% for their effects. When detected in surface waters, they occurred at concentrations of dozens to hundreds of ng/L. In wastewaters, they reached up to several μg/L. Effects of cardiovascular drugs and lipid regulating agents have been extensively studied in fish and a few in invertebrates, such as Daphnia magna and mussels. These pharmaceuticals affect cardiac physiology, lipid metabolism, growth and reproduction. Besides, effects on spermatogenesis and neurobehavior are observed. Environmental risks are associated with beta-blockers propranolol, metoprolol, and lipid lowering agents bezafibrate and atorvastatin, where adverse effects (biochemical and transcriptional) occurred partially at surface water concentrations. In some cases, reproductive effects occurred at environmentally relevant concentrations. This review summarizes the state of the art on the occurrence of cardiovascular drugs and lipid regulating agents at a global-scale and highlights their risks to fish. Further research is needed to include more subtle changes on heart function and to explore non-investigated drugs. Their occurrence in freshwaters and impact on a diverse array of aquatic organisms are particularly needed to fully assess their environmental hazards and risks.

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