What are the deleterious cardiovascular effects of nicotine vapes, especially in individuals with pre-existing cardiovascular conditions such as hypertension, coronary artery disease, or heart failure?

Proven Cardiovascular Harms of Nicotine Vapes

Nicotine vapes cause acute cardiovascular harm through increased blood pressure, heart rate, myocardial oxygen demand, and arterial narrowing with each exposure, while contributing to progressive atherosclerosis that doubles 10-year fatal cardiovascular risk regardless of consumption amount. 1

Immediate Hemodynamic Effects

Nicotine from vapes produces measurable acute cardiovascular responses:

• Each vaping episode increases systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate, with the magnitude of response equivalent to combustible cigarettes 2
• Nicotine directly increases myocardial oxygen demand while simultaneously causing arterial narrowing, creating a dangerous mismatch between oxygen supply and demand 1
• The FDA drug label specifically warns that nicotine can increase heart rate and blood pressure, requiring medical consultation before use in patients with heart disease, recent myocardial infarction, irregular heartbeat, or uncontrolled hypertension 3

Critical pitfall: Vapers consume nicotine at 48.2% of all 15-minute waking intervals compared to only 18.1% for smokers, meaning cardiovascular stress occurs nearly continuously throughout the day with minimal recovery periods 2. This pattern creates sustained hemodynamic burden far exceeding traditional smoking.

Progressive Vascular Damage

Beyond acute effects, nicotine vapes cause cumulative structural harm:

• Nicotine contributes to arterial wall hardening (atherosclerosis) that accumulates over years of use, with damage leading to myocardial infarction 1
• The 10-year fatal cardiovascular risk approximately doubles in all nicotine users with no safe lower threshold identified 1
• While e-cigarettes appear to affect endothelial function, vascular stiffness, and blood pressure less than combustible cigarettes, physiologic and toxicology studies demonstrate they still increase cardiovascular risk 4

Evidence Quality and Limitations

The American Heart Association/American College of Cardiology acknowledges that no data are available on the long-term risks of e-cigarettes on overall health and cardiovascular risk 4. However, this absence of long-term data does not indicate safety—rather, it reflects the recent emergence of these products.

Recent epidemiological evidence indicates e-cigarettes function as an independent risk factor for increased cardiovascular disease occurrence and death, with modest growth in cardiac arrhythmia, hypertension, acute coronary syndromes, and heart failure among vapers 5. The underlying mechanisms involve oxidative stress, inflammation, endothelial dysfunction, atherosclerosis, hemodynamic effects, and altered platelet function 5.

High-Risk Populations

Patients with pre-existing cardiovascular conditions face amplified risk:

• The FDA mandates medical consultation before nicotine use in patients with heart disease, recent heart attack, irregular heartbeat, or uncontrolled hypertension 3
• Users should immediately discontinue and seek medical attention if irregular heartbeat or palpitations occur 3
• In liver transplant recipients (who often have cardiovascular comorbidities), smoking causes vascular events in 18% versus 8% of nonsmokers, including hepatic artery thrombosis, portal vein thrombosis, and deep vein thrombosis 6

Clinical Recommendations

Healthcare providers should unequivocally recommend that individuals avoid both smoking and vaping for optimal health outcomes, as there is no safe level of nicotine exposure 1. The American Heart Association/American College of Cardiology specifically states that because of the lack of long-term safety data and high rates of ongoing dependence, nicotine e-cigarettes should not be recommended as first-line therapy for smoking cessation 4.

For patients already using e-cigarettes:

• Warn about risks of developing long-term dependence (80% of successful quitters still using devices at 1 year) 4
• Encourage prompt cessation to avoid potential long-term cardiovascular risks 4
• Implement standard smoking cessation therapies including counseling, nicotine replacement therapy, bupropion, or varenicline as alternatives 6

The cardiovascular harms are dose-dependent and frequency-dependent, with the near-continuous consumption pattern of vaping creating sustained cardiovascular stress that may exceed traditional smoking despite lower peak nicotine levels 2.