Does vaping affect the heart?

Does Vaping Affect the Heart?

Yes, vaping does affect the heart and poses cardiovascular risks, though these risks appear to be less than combustible cigarettes. E-cigarettes and their aerosol constituents—including nicotine, vaporizing solvents, particulate matter, metals, and flavorings—have deleterious effects on the cardiovascular system 1.

Cardiovascular Mechanisms of Harm

Nicotine-Mediated Effects

Nicotine from vaping causes direct cardiovascular harm through multiple pathways 1:

• Increases blood pressure and heart rate 1
• Increases blood flow to the heart 1
• Causes narrowing of the arteries 1
• Contributes to hardening of arterial walls (atherosclerosis), which can lead to heart attack 1
• Triggers irregular heartbeat or palpitations 2

Beyond Nicotine

E-cigarettes contain and emit numerous potentially toxic substances beyond nicotine 1:

• Oxidants and aldehydes that contribute to oxidative stress 3
• Particulate matter that affects cardiovascular function 1
• Metals and flavorings with unknown cardiovascular effects 1, 4
• Variable toxic substance exposure depending on device characteristics and usage patterns 1

Clinical Evidence of Cardiovascular Risk

Acute Effects

Studies demonstrate immediate cardiovascular dysfunction from vaping 5:

• Endothelial dysfunction measured by impaired flow-mediated dilation in acute exposure settings 5
• Vascular dysfunction from e-cigarette aerosol exposure 5
• Neurohumoral activation and inflammatory responses 3

Epidemiological Risk

Population studies show concerning associations 5:

• Increased risk for cardiovascular disease among e-cigarette users 5
• Potential increased risk of coronary heart disease events, though to a lesser degree than cigarette smoking 1

Comparative Risk: Less Harmful Does Not Mean Harmless

Risk Relative to Combustible Cigarettes

E-cigarette use likely poses less cardiovascular risk than combustible tobacco cigarettes when comparing toxic constituents 1. However, this comparison uses "a very high-risk comparator" 1.

The American Heart Association, World Heart Federation, American College of Cardiology, and European Society of Cardiology jointly state that while e-cigarettes may pose less risk than combustible cigarettes, there is growing evidence of deleterious cardiovascular effects 1.

Critical Limitations

Long-term cardiovascular outcome data are lacking 1, 3:

• No long-term epidemiological studies exist due to rapid product evolution since the mid-2000s 1
• Long-term cardiovascular risks remain unknown 1
• Physiologic and toxicology studies suggest e-cigarettes may increase cardiovascular risk 1

Special Populations at Risk

Youth and Adolescents

Vaping poses particular cardiovascular threats to young people 1:

• Nicotine exposure during adolescence causes addiction and harms the developing brain 1
• High-nicotine delivery systems (like JUUL) transformed the landscape and increased addiction potential 1
• Gateway effect: E-cigarette use is associated with increased odds of smoking combustible cigarettes among adolescents 1

Patients with Existing Cardiovascular Disease

Those with underlying coronary heart disease face heightened risk 4:

• Nicotine might contribute to acute cardiovascular events, especially in patients with existing cardiovascular disease 4
• Patients with chronic coronary disease should be screened for e-cigarette use as part of comprehensive risk assessment 1

Clinical Recommendations

For Smoking Cessation

E-cigarettes should not be recommended as first-line therapy for smoking cessation 1:

• Nicotine replacement therapy, bupropion, and varenicline are proven first-line pharmacotherapies 1
• While nicotine e-cigarettes may be more effective than nicotine replacement therapy for smoking cessation (4% absolute increase in success rates), 80% of successful quitters remain dependent on e-cigarettes at one year 1
• High rates of ongoing use and lack of long-term safety data preclude first-line recommendation 1

If Patients Use E-Cigarettes for Cessation

Patients with cardiovascular disease who use e-cigarettes to quit smoking should be 1:

• Warned about risks of developing long-term dependence 1
• Encouraged to quit e-cigarettes promptly to avoid potential long-term cardiovascular risks 1

Screening and Counseling

All patients should be assessed for vaping 1:

• Screen for e-cigarette use at every healthcare visit, especially given increasing dual use with combustible cigarettes 1
• Counsel about cardiovascular risks even in the absence of complete long-term data 1
• Advise complete avoidance for never-smokers, particularly youth 1

Common Pitfalls to Avoid

Do not assume e-cigarettes are "safe" alternatives—while potentially less harmful than combustible cigarettes, they carry independent cardiovascular risks 1, 3.

Do not overlook dual users—many cigarette smokers use both e-cigarettes and traditional cigarettes, maintaining high cardiovascular risk 1.

Do not dismiss youth vaping as harmless—the unprecedented increase in youth e-cigarette use represents a clear public health threat with cardiovascular implications 1.

Do not recommend e-cigarettes as first-line cessation therapy—proven pharmacotherapies (nicotine replacement therapy, varenicline, bupropion) combined with behavioral therapy remain the evidence-based approach 1.