Cardiovascular Health Effects and Synthetic Cooling Agents in E‐Cigarettes Labeled as “Clear” Marketed in Massachusetts After the Tobacco Product Flavoring Ban
Year: 2025
Type: article
Abstract: BACKGROUND: After Massachusetts enacted regulation on flavored tobacco products in 2020, electronic cigarettes (e-cigarettes) labeled "clear" emerged in the state. We studied their acute hemodynamic impact and chemical composition. METHODS: In participants (age 18-45 years) in the Cardiovascular Injury due to Tobacco Products 2.0 study (Boston, MA), we measured changes in blood pressure and heart rate following a structured use of participants' own e-cigarettes. We compared "clear" e-cigarette users (N=23) with non-"clear" flavored e-cigarette users (N=111) and nonusers (N=73). We used gas chromatograph coupled with mass spectroscopy to characterize and quantify the presence of synthetic cooling agents (WS-3, WS-23), menthol, and nicotine, and other flavorants in 19 "clear" e-cigarettes. RESULTS: All "clear" e-liquids contained the synthetic cooling agents WS-23 and/or WS-3, 18/19 contained menthol, and 12/19 products contained other flavorants. JUUL e-liquids did not contain synthetic coolants. Baseline blood pressure and heart rate measures were similar between "clear" and non-"clear" flavored e-cigarette users. Following acute use, "clear" e-cigarettes resulted in a greater increase in blood pressure and heart rate compared to both non-"clear" flavored e-cigarette use and nonuse, which remained largely consistent in multivariable models. For sensitivity analysis of comparing "clear" users to the subgroup of JUUL non-"clear" flavored users, the directions of associations were similar. CONCLUSIONS: The presence of synthetic cooling agents along with traditional flavorants in "clear" e-cigarette products available in the Massachusetts marketplace undermines the efficacy of the flavor ban. The potential that "clear" e-cigarettes induced more pronounced hemodynamic effects necessitates further study of the health impact of these products and synthetic cooling agents. REGISTRATION: URL: https://www.medrxiv.org/content/10.1101/2024.04.18.24305863v1, medRxiv. 10.1101/2024.04.18.24305863.
Institutions: Boston University, Yale University, University of Louisville
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,810
Awards: G146293445, G3916269547, G6031359796, Rapidly Advancing Discovery to Arrest the Outbreak of Youth Vaping (VAPERACE), G6646852615, G9000291477, Yale Center for the Study of Tobacco Product Use and Addiction (YCSTP), G927571801, American Heart Association Tobacco Center for Regulatory Science (A-TRAC) 2.0
OpenAlex ID: W4413106628