SAT-847 - The Knowing-Doing Gap in Endocrine Disruption: Uneven Integration Ofenvironmental Health Knowledge into Clinical Practice Guidelines

Background: Since the Endocrine Society’s initial Scientific Statement on endocrine-disrupting chemicals (EDCs) in 2009, environmental exposures have increasingly been recognized as contributors to endocrine and cardiometabolic disease risk, with the Society’s 2025 Position Statement reflecting an emerging scientific consensus. Despite this awareness, however, it remains unclear how EDCs and other environmental health threats are integrated into clinical guidance and patient care.

Objective: To evaluate the extent to which environmental health knowledge has been implemented into disease-focused guidelines across cardiometabolic conditions.

Methods: We systematically reviewed clinical guidelines and practice statements published between 2007 and 2026 addressing obesity, diabetes, diabetes-related complications, dyslipidemia, and cardiovascular disease. Comparator guidelines from pulmonology (asthma and chronic obstructive pulmonary disease) and obstetrics/gynecology were also analyzed. Guidelines were screened for 62 predefined environmental health-related terms. Environment-relevant terms were identified and scored within disease-specific sections and then underwent a whole-term keyword scan of environmental statements using disease-specific dictionaries. Terms were independently reviewed by three investigators to determine relevance to EDCs and climate change-related factors. Deduplicated counts were visualized in section-level and year-sorted heatmaps.

Results: Among 75 CMD guidelines reviewed, only 24 meaningfully acknowledged health risks related to environmental toxicant exposure or climate change-related factors. Although terms such as “environment” and “exposure” appeared frequently, their usage was often nonspecific or unrelated to toxicant exposure. Explicit references to chemical contributors to cardiometabolic disease risk were limited to a small subset of guidelines, with most references in guidelines or sections of guidelines related to cardiovascular disease. In contrast, pulmonary guidelines consistently and clearly linked occupational and ambient pollutant exposures to disease risk.

Conclusion: Despite burgeoning evidence connecting environmental factors to cardiometabolic dysfunction, relevant clinical practice guidelines insufficiently incorporated environmental factors in discussion of disease pathogenesis, offered actionable exposure reduction strategies, or advocated for further scientific study or policy interventions. This knowledge-to-action gap undercuts individual- and systems-levels interventions to fully address cardiometabolic disease risk. Addressing this translational chasm is critical for reducing the overall burden of cardiometabolic disease and eliminating critical health disparities.

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