The American Heart Association is raising awareness about the growing body of scientific evidence linking e-cigarette chemicals to potential cardiovascular harm, as policymakers evaluate the rapidly evolving market of tobacco and nicotine products. Research studies show that several chemicals found in e-cigarettes and produced when used as intended may damage the heart and blood vessels.
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), including substances the FDA classifies as harmful or potentially harmful constituents. A study published earlier this month in Circulation: Arrhythmia and Electrophysiology 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 and chief of the division of pulmonary, critical care and sleep medicine at the University of Maryland School of Medicine. Rose served as writing group chair of the 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.
Research suggests that inhaling e-cigarette aerosol may contribute to conditions that can lead to heart disease, including oxidative stress, inflammation, damage to blood vessel function, and changes that can lead to atherosclerosis, a buildup of fatty plaque in the arteries. Nearly all e-cigarettes contain natural or synthetic 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 and heart failure, according to the American Heart Association. Nicotine also can increase blood clotting and contribute to peripheral artery disease, which reduces blood flow and raises the risk of serious cardiovascular events, including lower limb amputation.
One e-cigarette can contain as much or more nicotine as a pack of cigarettes, increasing the risk of addiction. Nicotine fuels a powerful addiction cycle, with temporary calm followed by irritability, anxiety, difficulty concentrating and strong cravings as nicotine levels drop. Claims of cognitive benefits from nicotine are not supported by evidence; research suggests that while nicotine may produce short-term changes in attention, these effects are modest and often reflect relief from withdrawal symptoms rather than true improvement. 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.
Public health experts are especially concerned about e-cigarette use among young people. Most youth who use e-cigarettes report using flavored products, which appeal to young people and can increase the likelihood of continued use and use of other tobacco products. 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 and nicotine products should be sold in the United States.
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, prevent initiation and strengthen research. The Association also supports access to proven, evidence-based cessation tools, including FDA-approved nicotine replacement therapies, 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.”
