Toxicological Profile Of Electronic Cigarette Use: A Literature-Based Review

Abstract

Electronic cigarettes (e-cigarettes) are rapidly expanding products marketed as alternatives to conventional tobacco products and are often promoted as being less harmful. However, current literature indicates that e-cigarettes may pose significant health risks due to their complex toxicological profile. E-cigarette aerosols contain a variety of toxic chemicals, including nicotine, propylene glycol, vegetable glycerin, carbonyl compounds (formaldehyde, acetaldehyde, acrolein), heavy metals, aromatic additives, and volatile organic compounds. Many of these substances are formed through termal degradation and have been associated with oxidative stress, inflammation, cellular toxicity, and genotoxic effects. These toxicants exert adverse effects on oral and dental tissues as well as the pulmonary and cardiovascular systems, and several exhibit potential carcinogenic properties. Nicotine is a highly addictive alkaloid with pronounced effects on cardiovascular stress, sympathetic nervous system activation, and reward pathways. Although nicotine concentrations in e-cigarettes are often reported to be lower than those in conventional cigarettes, exposure levels may vary substantially depending on device type and technical characteristics. Similarly, other toxic constituents are generally present at lower levels in e-cigarette aerosols; nevertheless, individual exposure may differ markedly according to device design, heating temperature, e-liquid composition, and user behavior. E-cigarette use has been potentially associated with various adverse health outcomes, including chronic bronchitis, asthma, chronic obstructive pulmonary disease (COPD), e-cigarette or vaping use-associated lung injury (EVALI), inflammatory and microbiome-related alterations in oral and dental tissues. Cardiovascular effects resemble those of conventional cigarette smoking and include endothelial dysfunction, atherosclerosis, elevated blood pressure, increased heart rate, and a heightened risk of cardiovascular disease. The widespread use of new-generation disposable devices, particularly among adolescent and young adults, underscores the importance of identifying long-term health risks. This narrative review systematically evaluates the toxicological effects of e-cigarettes, highlighting both acute and chronic health risks. Future long-term epidemiological studies are essential to accurately assess these risks and to inform evidence-based public health policies.

Keywords

• Aerosol
• E-Cigarette
• EVALI
• Nicotine
• Toxicology

References

1. Münzel T, Kuntic M, Stamm P, Daiber A. E-cigarettes and vaping: new spotlight on smoking as an old cardiovascular risk factor? Herz. 2024;49(6):441-447. doi:10.1007/s00059-024-05278-7
2. T.C. Sağlık Bakanlığı. Elektronik sigara ve yeni nesil tütün ürünleri politika değerlendirme raporu. 2025.
3. Bennani I, Alami Chentoufi M, El Karbane M, Cheikh A, Bouatia M. E-cigarette quality control: impurity and nicotine level analysis in electronic cigarette refill liquids. Sci World J. 2020;2020:3050189. doi:10.1155/2020/3050189
4. Şen H, Yıldıztekin G. Elektronik sigara kullanımının toksikolojik açıdan değerlendirilmesi. Curr Res Health Sci. 2025;2(3):148-156.
5. Hickman E, Jaspers I. Evolving chemical landscape of e-cigarettes. Tob Control. 2021;31(e1):e1.
6. Alshareef HZ, Omaye ST. Toxicology of commonly found ingredients in e-cigarettes: a brief review. Health. 2021;13(11):1396-1409.
7. Almeida-da-Silva CLC, Matshik Dakafay H, O’Brien K, Montierth D, Xiao N, Ojcius DM. Effects of electronic cigarette aerosol exposure on oral and systemic health. Biomed J. 2021;44(3):252-259.
8. Yılmazcan P,AtasoyAydınA, Dağlıoğlu N. Yeni nesil güvenlik tehlikesi: elektronik sigaralar.J Secur Sci. 2025;14(1):441-460.

9. Havaçeliği Atlam D, Şaşman Kaylı D, Yararbaş G, et al. Elektronik sigara kullanımına yönelik tutum ve kullanım özellikleri: İzmir örneklemi. Bagimlilik Derg. 2020;21(4):297-307.
10. Naeem M, Nawi M, Sayed SM, et al. Chemical constituents in e-cigarette liquids and aerosols.JEnviron Prot. 2020;11(9):664-681.
11. Gordon T, Karey E, Rebuli ME, Escobar YNH, Jaspers I, Chen LC. E-cigarette toxicology. Annu Rev Pharmacol Toxicol. 2022;62:301-322.
12. Cohen JE. Broad range of research on e-cigarettes. Tob Control. 2023;32(e2):e137-e138.
13. Leavens ELS, Wagener TL. E-cigarettes and FDA nicotine cap. JAMA. 2024;331(4):358.
14. Rose JJ, Krishnan-Sarin S, Exil VJ, et al. Cardiopulmonary impact of electronic cigarettes and vaping products: a scientific statement from the American Heart Association. Circulation. 2023;148(8):703-728.
15. Kuntic I, Kuntic M, Oelze M, et al. The role of acrolein for e-cigarette vapour condensate-mediated activation of NADPH oxidase. Pflugers Arch. 2023;475(7):807-821.
16. Son Y, Weisel C, Wackowski O, et al. The impact of device settings, use patterns, and flavorings on carbonyl emissions from electronic cigarettes. Int J Environ Res Public Health. 2020;17:1-14.
17. Sharma S, Meister M, He X, et al. Puffing topography: a tool to evaluate vaping behavior and exposure risks. Inhal Toxicol. 2025.
18. Li Y, Burns AE, Tran LN, et al. Impact of e-liquid composition, coil temperature, and puff topography on the aerosol chemistry of electronic cigarettes. Chem Res Toxicol. 2021;34:1640-1654.
19. Li X, Yuan L, Wang F. Health outcomes of electronic cigarettes. Chin Med J (Engl). 2024;137(16):1903.
20. XieW, Kathuria H, Galiatsatos P, et al.Association of electronic cigarette use with incident respiratory conditions among US adults. JAMA Netw Open. 2020;3(11):e2020816.
21. Tituana NY, Clavijo CG, Espinoza EF, Tituana VA. E-cigarette use–associated lung injury (EVALI). Pneumologie. 2024;78(1):58-69.
22. Park JA, Crotty Alexander LE, Christiani DC. Vaping and lung inflammation and injury. Annu Rev Physiol. 2022;84:611-629.
23. Güler et al. Eurasian J Tox. 2025;6(3): 60-65 Toxicological Profile Of Electronic Cigarette Use: A Literature-Based Review 65
24. Gaiha SM, Cheng J, Halpern-Felsher B. Association between youth smoking, electronic cigarette use, and COVID-19. J Adolesc Health. 2020;67(4):519-523.
25. Li D, Croft DP, Ossip DJ, Xie Z. The association between statewide vaping prevalence and COVID-19. Prev Med Rep. 2020;20:101254.
26. Virgili F, Nenna R, Ben David S, et al. E-cigarettes and youth: an unresolved public health concern. Ital J Pediatr. 2022;48(1):97.
27. Bao X, Hu H, Dun Y, et al. A mouse model of e-cigarette or vaping product use–associated lung injury induced by vitamin E acetate. Respir Res. 2025;26(1):263.
28. Cao DJ, Aldy K, Hsu S, et al. Review of health consequences of electronic cigarettes and the outbreak of EVALI. J Med Toxicol. 2020;16(3):295-310.
29. Ebersole J, Samburova V, Son Y, et al. Harmful chemicals emitted from electronic cigarettes and potential deleterious effects in the oral cavity. Tob Induc Dis. 2020;18:41.
30. Niemczyk S, Niemczyk W, Prokurat M, et al. Impact of e-cigarettes on oral health: literature review. Pol Merkur Lekarski. 2023;51(3):271-275.
31. Holliday R, Chaffee BW, Jakubovics NS, Kist R, Preshaw PM. Electronic cigarettes and oral health. J Dent Res. 2021;100(9):906-913.
32. Irusa KF, Vence B, Donovan T. Potential oral health effects of e-cigarettes and vaping: a review and case reports. J Esthet Restor Dent. 2020;32(3):260-264.
33. Cichońska D, Kusiak A, Goniewicz ML. The impact of e-cigarettes on oral health: a narrative review. Dent J. 2024;12.
34. Yammine L, Tovar M, Yammine NA, Becker C, Weaver MF. E-cigarettes and youth: the known, the unknown, and implications for stakeholders. J Addict Med. 2024;18(4):360-365.
35. Neczypor EW, Mears MJ, Ghosh A, et al. E-cigarettes and cardiopulmonary health: a review for clinicians. Circulation. 2022;145(3):219-232.
36. Larue F, Tasbih T, Ribeiro PAB, et al. Immediate physiological effects of acute electronic cigarette use in humans: a systematic review and meta-analysis. Respir Med. 2021;190:106684.
37. Abelia XA, Lesmana R, Goenawan H, Abdulah R, Barliana MI. Comparison impact of cigarettes and e-cigs as lung cancer risk inductor: a narrative review. Eur Rev Med Pharmacol Sci. 2023;27(13):6301-6318.
38. Petrella F, Rizzo S, Masiero M, et al. Clinical impact of vaping on cardiopulmonary function and lung cancer development. Eur J Cancer Prev. 2023;32(6):584-589.
39. Sahu R, Shah K, Malviya R, et al. E-cigarettes and associated health risks: an update on cancer potential. Adv Respir Med. 2023;91(6):516-531.
40. Bracken-Clarke D, Kapoor D, Baird AM, et al. Vaping and lung cancer: a review of current data and recommendations. Lung Cancer. 2021;153:11-20