Is vaping bad for my health? As people who use e-cigarettes and their loved ones pose questions like this, growing scientific evidence shows that the answer is yes. Research studies show that several chemicals found in e-cigarettes and produced when used as intended may harm heart health.
As policymakers evaluate the rapidly evolving market of tobacco and nicotine products, the American Heart Association, a global force changing the future of health for all, says everyone should be aware of the scientific evidence pointing to potential cardiovascular harms.
Often misrepresented and misunderstood as harmless water vapor, e-cigarette aerosol often contains a mix of chemicals, additives, sweeteners and flavoring agents, according to the U.S. Food and Drug Administration (FDA). These include substances the FDA classifies as harmful or potentially harmful constituents.
In a study published earlier this month in Circulation: Arrhythmia and Electrophysiology, researchers 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 in Baltimore. Rose served as writing group chair of the American 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
Emerging research is painting a clearer picture of chemical exposure from e-cigarette use:
- 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.
How vaping may affect the heart and brain
Researchers are also learning more about how exposure to e-cigarette chemicals may affect the cardiovascular system.
Research suggests that inhaling e-cigarette aerosol may contribute to several conditions that can lead to the development of heart disease, including:
- Oxidative stress, which is when harmful chemicals damage cells and tissues over time, and inflammation
- Damage to blood vessel function
- Changes in the body that can lead to atherosclerosis, a buildup of fatty plaque in the arteries
Nicotine adds to cardiovascular strain
Nearly all e-cigarettes, pouches and other tobacco products contain natural or synthetic nicotine, a highly addictive chemical that can raise blood pressure and heart rate, narrow blood vessels and force the heart to work harder. Over time, these effects can lead to conditions such as 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.
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. Nicotine fuels a powerful addiction cycle in which a person can feel temporary calm, followed by growing irritability, anxiety, difficulty concentrating and strong cravings as nicotine levels drop. These symptoms are temporarily relieved when nicotine is used again, perpetuating continued use.
Claims of cognitive benefits are not supported by evidence
Some e-cigarette and nicotine products are marketed as improving focus, memory and mental performance. However, available evidence does not support lasting cognitive benefits from nicotine use. Research suggests that while nicotine may produce short-term changes in attention, these effects are modest and inconsistent. In people who use nicotine regularly, these effects often reflect relief from withdrawal symptoms rather than true improvement in brain function. 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 also on the rise
Public health experts, health care providers, policymakers and parents 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, can increase the likelihood of continued use and may also increase the likelihood of using other tobacco products over time.
According to the Heart Association, nicotine exposure during adolescence can have long-lasting effects on brain development, affecting attention, learning, impulse control and memory. This heightened sensitivity also makes young people more susceptible to addiction, even at lower levels of exposure, raising concerns about newer products that can deliver higher doses of nicotine more efficiently.
Protecting heart health
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 has long supported public policies at the federal, state and local levels to prohibit the sale of all flavored commercial tobacco and nicotine products, including menthol, and to support quitting, prevent initiation and strengthen research to better understand health impacts.
The Heart Association also supports access to proven, evidence-based cessation tools to help people who use tobacco quit for good. FDA-approved nicotine replacement therapies, along with counseling and other cessation supports, are safe and effective options to reduce withdrawal symptoms and increase the likelihood of quitting successfully. Helping individuals transition away from all tobacco and nicotine products remains a critical part of improving cardiovascular health.
“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.”
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