As policymakers evaluate the rapidly evolving market of tobacco and nicotine products, the American Heart Association emphasizes that growing scientific evidence links e-cigarette chemicals to potential cardiovascular harms. Often misrepresented as harmless water vapor, e-cigarette aerosol contains a mix of chemicals, additives, sweeteners, and flavoring agents, including substances classified by the U.S. Food and Drug Administration 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 at the University of Maryland School of Medicine. "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, 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.
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. Nearly all e-cigarettes contain natural or synthetic nicotine, which raises blood pressure and heart rate, narrows blood vessels, and forces 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 increases blood clotting and contributes to peripheral artery disease.
Adding to concerns is the level of nicotine in e-cigarettes. 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; research suggests that any short-term changes in attention reflect relief from withdrawal 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.
Youth use concerns are also on the rise. Most youth who use e-cigarettes report using flavored products, which appeal to young people and increase the likelihood of continued use and progression to other tobacco products. The Heart Association emphasizes that nicotine exposure during adolescence can have long-lasting effects on brain development.
These findings come as federal and state officials consider whether e-cigarettes should be sold in the United States. The American Heart Association supports policies to prohibit the sale of all flavored commercial tobacco and nicotine products, including menthol, and to support quitting. "The tobacco industry relentlessly targets kids and communities with fruit-, candy-, and menthol-flavored tobacco products," said Nancy Brown, CEO of the American Heart Association. "No tobacco or nicotine product can be considered safe."
