As the use of e-cigarettes continues to rise, growing scientific evidence points to potential cardiovascular harms from chemicals found in these products and produced when used as intended. The American Heart Association, a global force changing the future of health for all, says everyone should be aware of the research linking e-cigarette aerosol to heart health risks.
Often misrepresented as harmless water vapor, e-cigarette aerosol contains a mix of chemicals, additives, sweeteners and flavoring agents, according to the U.S. Food and Drug Administration (FDA). These include substances the FDA classifies as harmful or potentially harmful constituents. In a study published earlier this month in Circulation: Arrhythmia and Electrophysiology, researchers found that synthetic cooling chemicals used in some e-cigarettes may disrupt heart rhythm, pointing to potential risks such as irregular heartbeat and cardiac arrest.
“We’ve long known about the health threats of cigarettes and other traditional tobacco products, but as increasing numbers of e-cigarettes and other newer nicotine products are introduced into the market, we are learning more about the health threats of these products,” said Jason J. Rose, M.D., M.B.A., American Heart Association volunteer and associate professor of medicine at the University of Maryland School of Medicine. Rose served as writing group chair of the American Heart Association’s 2023 scientific statement on e-cigarettes. “A growing body of research shows that people who use e-cigarettes can be exposed to chemicals that can harm the heart and blood vessels.”
Multiple lines of evidence point to potential harm. Studies show e-cigarettes expose people to multiple toxic substances, such as formaldehyde and heavy metals, that are linked to cardiovascular, respiratory and cancer-related health risks. Nicotine, in addition to being highly addictive, can damage the heart and other vital organs. Researchers are increasingly able to determine how much of these chemicals people are exposed to using these products.
How vaping may affect the heart and brain is also becoming clearer. Research suggests that inhaling e-cigarette aerosol may contribute to oxidative stress, inflammation, damage to blood vessel function, and changes that can lead to atherosclerosis. Nicotine adds to cardiovascular strain by raising blood pressure and heart rate, narrowing blood vessels, and forcing the heart to work harder. Over time, these effects can lead to heart attack, stroke, and heart failure, according to the American Heart Association. One e-cigarette can contain as much or more nicotine as a pack of cigarettes, increasing the risk of addiction.
Claims of cognitive benefits from nicotine are not supported by evidence. While nicotine may produce short-term changes in attention, these effects are modest and inconsistent. Over time, nicotine exposure, especially among young people, can harm brain development and is associated with changes in attention, learning, and impulse control, according to the Centers for Disease Control and Prevention.
Youth use concerns are also on the rise. Most youth who use e-cigarettes report using flavored products, which appeal to young people and can increase the likelihood of continued use. According to the Heart Association, nicotine exposure during adolescence can have long-lasting effects on brain development, affecting attention, learning, impulse control, and memory.
These findings come as federal and state officials consider whether e-cigarettes and other commercial tobacco products should be sold in the United States. The American Heart Association has long supported public policies to prohibit the sale of all flavored commercial tobacco and nicotine products, including menthol, and to support quitting, prevent initiation, and strengthen research. The association also supports access to proven, evidence-based cessation tools to help people quit for good.
“The tobacco industry relentlessly targets kids and communities with fruit-, candy- and menthol-flavored tobacco products that encourage use, facilitate addiction and increase profits,” said Nancy Brown, chief executive officer of the American Heart Association. “After decades of selling products that cause disease and death, tobacco and nicotine companies cannot be trusted to protect public health. No tobacco or nicotine product can be considered safe.”
