Growing Evidence Links E-Cigarette Chemicals to Heart Health Risks, Warns American Heart Association

The American Heart Association is drawing attention to mounting scientific evidence that e-cigarettes pose significant risks to cardiovascular health. As policymakers evaluate the rapidly evolving market of tobacco and nicotine products, the organization emphasizes that everyone should be aware of the potential harms, which are often misrepresented as harmless water vapor.

According to the U.S. Food and Drug Administration (FDA), e-cigarette aerosol frequently contains a mix of chemicals, additives, sweeteners and flavoring agents, including substances classified as harmful or potentially harmful. A study published this month in Circulation: Arrhythmia and Electrophysiology found that synthetic cooling chemicals used in some e-cigarettes may disrupt heart rhythm, pointing to 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 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 users to toxic substances such as formaldehyde and heavy metals 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 when using these products.

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. Nearly all e-cigarettes contain nicotine, which can raise blood pressure and heart rate, narrow blood vessels and force the heart to work harder. Over time, these effects can lead to heart attack, stroke, heart failure, and peripheral artery disease. One e-cigarette can contain as much or more nicotine as a pack of cigarettes, increasing addiction risk.

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 often reflect relief from withdrawal symptoms. Over time, nicotine exposure can harm brain development, especially among young people, and is associated with changes in attention, learning and impulse control, according to the Centers for Disease Control and Prevention.

Public health experts are especially concerned about youth use, as most young users report using flavored products, which appeal to kids and increase the likelihood of continued use. The American Heart Association supports public policies to prohibit the sale of all flavored commercial tobacco and nicotine products, including menthol, and to support quitting and prevent initiation.

“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.”

For more information on quitting smoking and vaping, visit the American Heart Association’s resource on Five Steps to Quit Smoking and Vaping. Additional details on the organization’s policy positions can be found here.