New Review Warns of Hidden Health Risks From E-Cigarette Flavoring Agents

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PASADENA, Calif. — November 18, 2023 — A new publication co-authored by Dr. Robert A. Kloner, Dr. Wangde Dai, and Dr. Jianru Shi of Huntington Medical Research Institutes (HMRI) highlights growing evidence that the chemical flavoring agents used in e-cigarettes may themselves pose significant health risks — independent of nicotine exposure.

Published in Cureus, the paper — “Flavoring Agents in E-Cigarette Liquids: A Comprehensive Analysis of Multiple Health Risks” — reviews a decade of emerging studies on how popular flavoring compounds affect the cardiovascular, respiratory, and nervous systems.

The multidisciplinary team — Jaspreet Sachdeva, Anisha Karunananthan, Jianru Shi, Wangde Dai, Michael T. Kleinman, David A. Herman, and Robert A. Kloner — synthesized findings from experimental and clinical research on compounds commonly used to create flavors such as cinnamaldehyde (cinnamon), vanillin (vanilla), benzaldehyde (cherry), ethyl maltol (sweet), menthol, and dimethylpyrazine.

Key conclusions include:

  • Flavoring agents can harm cardiovascular health, reducing endothelial nitric oxide availability, impairing vessel dilation, and altering cardiac electrical activity.

  • These agents can trigger oxidative stress, inflammation, and DNA damage — effects observed even without nicotine.

  • Toxicity varies depending on flavoring type, concentration, and exposure duration, but virtually all tested compounds show some degree of cellular or vascular dysfunction.

  • Current research remains limited, underscoring an urgent need for systematic preclinical and clinical studies to evaluate long-term effects of flavored vaping products.

“This review underscores that flavoring agents are not inert additives,” said Dr. Kloner, Chief Science Officer at HMRI. “Their biological activity raises real concerns for cardiovascular and overall health — particularly among youth and chronic users.”

The publication contributes to HMRI’s expanding research portfolio on electronic cigarettes, nicotine toxicity, and cardiovascular injury mechanisms, building on multiple recent studies from the Institute’s cardiac physiology team.

Full article: Cureus, November 2023