E-Cigarette Chemicals Pose Growing Heart Health Risks, Research Shows

The American Heart Association is sounding an alarm about the cardiovascular dangers of e-cigarettes, citing mounting scientific evidence that chemicals found in these products can harm the heart and blood vessels. In a comprehensive review released Monday, the organization emphasized that e-cigarette aerosol, often mischaracterized as harmless water vapor, contains a mix of harmful substances including formaldehyde, heavy metals, and synthetic cooling agents that may disrupt heart rhythm.

“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 Dr. Jason J. Rose, a volunteer with the American Heart Association and associate professor of medicine at the University of Maryland School of Medicine. Rose chaired 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.”

A study published this month in Circulation: Arrhythmia and Electrophysiology found that synthetic cooling chemicals used in some e-cigarettes may disrupt heart rhythm, potentially leading to irregular heartbeat and cardiac arrest. This adds to concerns about oxidative stress, inflammation, and damage to blood vessel function that can contribute to atherosclerosis, a buildup of fatty plaque in the arteries.

Nearly all e-cigarettes contain nicotine, a highly addictive chemical that 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, raising the risk of lower limb amputation. One e-cigarette can contain as much or more nicotine as a pack of cigarettes, fueling a powerful addiction cycle.

Despite marketing claims that nicotine products improve focus and mental performance, evidence does not support lasting cognitive benefits. Research suggests that any short-term changes in attention often reflect relief from withdrawal symptoms rather than true improvement. Among young people, nicotine exposure 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 remains a critical concern, with most young users reporting flavored products that appeal to them and increase the likelihood of continued use. The American Heart Association supports policies to prohibit the sale of all flavored tobacco and nicotine products, including menthol, and advocates for access to evidence-based cessation tools such as FDA-approved nicotine replacement therapies.

“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.”

The findings come as federal and state officials consider whether e-cigarettes should remain on the market. The American Heart Association continues to urge robust regulation and comprehensive tobacco control to prevent initiation and support quitting.

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