The American Heart Association is raising awareness about the potential cardiovascular harms of e-cigarettes, as a growing body of scientific evidence links chemicals found in these products to heart health risks. In a statement, the organization emphasized that e-cigarette aerosol, often misrepresented as harmless water vapor, contains a mix of chemicals, additives, sweeteners and flavoring agents, including substances classified by the U.S. Food and Drug Administration (FDA) 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. 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, noted that while the health threats of traditional cigarettes are well-known, increasing numbers of e-cigarettes and newer nicotine products are revealing additional health dangers. Rose served as writing group chair of the association's 2023 scientific statement on e-cigarettes.
Multiple lines of evidence point to potential harm. Studies show that e-cigarettes expose users 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 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. 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, heart failure, and peripheral artery disease. 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 use are not supported by evidence. While nicotine may produce short-term changes in attention, these effects are modest and inconsistent, often reflecting 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.
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 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.
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 organization also supports access to proven cessation tools, including FDA-approved nicotine replacement therapies. Nancy Brown, CEO of the American Heart Association, stated, "The tobacco industry relentlessly targets kids and communities with fruit-, candy- and menthol-flavored tobacco products that encourage use, facilitate addiction and increase profits. 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."
