Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American Heart Association, 14(16), e036106. https://doi.org/10.1161/JAHA.124.036106 Dr. Erika T. Minetti et al.
Points
- E-cigarettes labeled “clear” appeared in Massachusetts after the state’s 2020 ban on flavored tobacco products, containing synthetic cooling agents to circumvent the new regulation potentially.
- Chemical analysis of 19 “clear” devices revealed that all contained synthetic coolants WS-23 and/or WS-3, while most also contained menthol and other traditional flavorants.
- Researchers compared 23 “clear” e-cigarette users to 111 non-“clear” flavored users and 73 nonusers, assessing hemodynamic changes after a structured 10-minute vaping session.
- Following acute use, “clear” e-cigarettes produced a significantly greater increase in systolic and diastolic blood pressure, mean arterial pressure, and heart rate than the other groups.
- The study concludes these products undermine flavor bans and their more pronounced hemodynamic effects necessitate further research into the health impacts of synthetic cooling agents.
Summary
A study led by researchers at Boston University and Yale University investigated the chemical composition and acute hemodynamic effects of e-cigarettes labeled “clear,” which emerged in Massachusetts following its 2020 ban on flavored tobacco products. The research involved 207 participants aged 18–45 years, comprising 23 “clear” e-cigarette users, 111 non-“clear” flavored users, and 73 nonusers. Hemodynamic changes were measured after a structured 10-minute session. Gas chromatography coupled with mass spectroscopy was used to analyze 19 “clear” e-cigarette liquids, with JUUL pods serving as a comparison.
Chemical analysis revealed that all 19 “clear” liquids contained the synthetic cooling agents WS-23 (14–37 mg/g) and/or WS-3 (1.8–25 mg/g in 7 samples), while 18 of 19 also contained menthol (0.5–9.2 mg/g) and 12 of 19 contained other flavorants. In contrast, JUUL “Menthol” pods contained menthol (10 mg/g) but no synthetic coolants. Nicotine concentrations in “clear” devices ranged from 28 to 53 mg/g, with measured content deviating from labels by -35% to +5%.
Following acute use, “clear” e-cigarettes induced a greater increase in systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate compared to both non-“clear” flavored e-cigarette use and nonuse. These associations remained significant in multivariable models adjusted for age, sex, combustible cigarette use, and puff count. The study concludes that “clear” e-cigarettes, containing both synthetic coolants and traditional flavorants, undermine the state’s flavor ban, and their more pronounced hemodynamic effects warrant further investigation into the cardiovascular impact of these products.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00577
References Minetti, E. T., Erythropel, H. C., Keith, R., Davis, D. R., Zimmerman, J. B., Krishnan‐Sarin, S., & Hamburg, N. M. (2025). Cardiovascular health effects and synthetic cooling agents in e‐cigarettes labeled as “clear” marketed in massachusetts after the tobacco product flavoring ban. Journal of the American Heart Association, 14(16), e036106. https://doi.org/10.1161/JAHA.124.036106
