Is there evidence that vaping causes long-term damage?

Long-Term Damage from Vaping: Current Evidence

There is insufficient evidence to determine the full extent of long-term damage from vaping, but emerging research indicates significant concerns about potential harm to cardiovascular, respiratory, and neurological systems. 1, 2

Current Evidence on Vaping Risks

Short-term Effects (Well-Established)

• Most commonly reported immediate adverse effects include:
  • Coughing
  • Nausea
  • Throat irritation
  • Sleep disruption 1
  • Increased blood pressure and heart rate 2
  • Narrowing of arteries 2

Long-term Concerns (Emerging Evidence)

Cardiovascular System

• Nicotine exposure may contribute to:
  • Coronary artery disease
  • Atherosclerosis
  • Aortic aneurysms
  • Irregular heartbeat
  • Hypertension 2

Respiratory System

• E-cigarette aerosols contain potentially toxic substances including:
  • Fine and ultrafine inhalable particles
  • Cancer-causing substances
  • Metal particles 2, 3
• Growing evidence suggests risk for:
  • Chronic obstructive lung disease
  • Respiratory dysfunction 2, 3

Neurological System

• Nicotine has neurotoxic effects, particularly on developing brains:
  • Affects learning, reasoning, and attention
  • Impacts impulse control and personality
  • May increase risk for psychopathology (e.g., ADHD, anxiety) 1, 2
  • Causes structural and functional alterations in brain areas related to emotion and decision-making 1

Special Considerations

EVALI (E-cigarette or Vaping Use-Associated Lung Injury)

• In 2019-2020, over 2,800 cases reported with 68 deaths
• Primarily linked to vitamin E acetate in THC-containing e-cigarettes
• Symptoms included cough, shortness of breath, chest pain, nausea, vomiting, and fever 1, 4

Vulnerable Populations

• Adolescents: Particularly vulnerable to nicotine's effects on brain development 1, 2

  • Animal models show unique neurochemical responses to nicotine in limbic circuitry
  • Long-term structural and functional changes in reward centers can begin after first exposure 1
  • Upregulation of striatal dopamine transporter density and increases in serotonergic transporter density 1

• Pregnant women: Nicotine crosses placenta affecting fetal development 2

Expert Consensus and Limitations

The US Preventive Services Task Force (2021) states:

• "Data on potential long-term harms of e-cigarette use are currently lacking" 1
• E-cigarettes contain and emit potentially toxic substances, though exposure is lower than with combustible cigarettes 1

The American Thoracic Society, American College of Cardiology, and American Academy of Pediatrics:

• Recommend against e-cigarettes for smoking cessation due to insufficient evidence on effectiveness and unclear balance of benefits/harms 2
• Emphasize no "safe" level of tobacco or nicotine consumption exists 2

Research Gaps

Current knowledge is limited by:

• Lack of long-term studies (vaping is relatively new)
• Rapidly evolving e-cigarette technology and formulations
• Need for standardization in quantifying e-cigarette use and nicotine exposure 1

The USPSTF has identified urgent research needs for:

• Better understanding of both short and long-term harms
• Studies on dual users of e-cigarettes and conventional cigarettes
• Research on newer generations of e-cigarettes 1

While some studies suggest potential harm reduction compared to conventional cigarettes 5, the World Health Organization does not endorse e-cigarettes as cessation aids 3, and emerging evidence raises substantial concerns about long-term safety 3, 6, 7.