Can Electronic Cigarette Use Lead to Cardiovascular Diseases?


An electronic cigarette is a battery-powered gadget that releases a vaporized substance for inhalation. The idea behind this device is to stimulate tobacco smoke inhalation without emitting smoke. E-cigarettes are often marketed as an alternative to tobacco to help users quit or reduce smoking. According to the Centers for Disease Control and Prevention, E-cigarettes can benefit adults who smoke and are not pregnant if utilized as a complete substitute for regular cigarettes and other smoked tobacco products. However, they also have the potential to harm others, and there is still a lot to uncover about the strengths and potential risks brought by e-cigarettes.

Regardless of the extensive use of cigarettes and the known dangerous cardiac impacts of nicotine, the effects of e-cigarettes on the cardiovascular system are not well-known. Several studies try to describe how electrical cigarettes impact the development of cardiovascular diseases, from the association of nicotine to other components of cigarettes down to unifying mechanisms of cardiovascular impairments resulting from using e-cigarettes. A review from Frontiers in Cardiovascular Medicine took the initiative to provide an outline of the contribution of e-cigarettes in the development of cardiovascular diseases, including their molecular foundations. In this article, we will provide a comprehensive summary of its highlights which may be crucial in our understanding of the impact of e-cigarettes on cardiovascular health.


The prevalent tobacco consumption in America can be traced back to prehistoric times. The Spanish physician and botanist Nicolás Monardes wrote a book outlining the medicinal effects of tobacco smoking on various health issues in the 16th century. Pathologists noted a significant correlation between lung cancer and cigarette smoking in the early 20th century. When the smoking rate peaked in the 1960s, 42% of American adults aged 18 and over were tobacco users. In addition to contributing to chronic obstructive pulmonary disease, various types of cancer, diabetes, and cardiovascular disease (CVD), smoking is currently the biggest cause of premature death and a risk factor for COVID-19. Despite a decline in cigarette consumption in recent years, the market launch of electronic cigarettes, often known as e-cigarettes, has led to a continuation of nicotine dependence. 

E-cigarettes and Cardiovascular Diseases

E-cigarettes are battery-operated devices that create a vapor by heating an e-liquid solution made up of flavoring, propylene glycol, glycerol, and nicotine. To increase the speed of release and yield of nicotine like traditional cigarettes, newer devices use strong atomizers and e-liquids with higher nicotine concentrations. Even at high nicotine concentrations, nicotine salts in pod models like the JUUL minimize harshness and produce a pleasurable experience. E-cigarette users who try to quit smoking frequently wind up using both products.

Concerning the development of cardiovascular diseases, smoking causes 11% of cardiovascular deaths globally. On the other hand, even though e-cigarettes can potentially be less dangerous than conventional cigarettes due to their lower concentration of harmful substances, the specific toxicological and mechanistic facts of the effects e-cigarettes have on the cardiovascular system have yet to be clarified. According to a cross-sectional review of cardiovascular symptoms, people who use e-cigarettes are more likely to have an arrhythmia, chest pain, or palpitations. Hence, it is important to study the impacts of e-cigarettes’ chemical composition on the development of cardiovascular diseases.

According to the Frontier’s review, some significant insights on the relationship between e-cigarettes and cardiovascular diseases development include:

  • High levels of unprotonated nicotine can cause a quick rising phase and higher peak concentration levels in arterial blood, which can lead to greater cardiovascular effects and an increase in the risk of cardiovascular events like cardiac arrhythmia, blood pressure fluctuations, and disruption of hemodynamic processes.
  • Insulin resistance and its numerous negative effects are the defects that raise smokers’ risk of CVD.
  • E-cigarettes with nicotine impact the generation of oxidative stress and inflammation.
  • According to clinical and preclinical studies, consuming e-cigarettes increases platelet aggregation, which can have a detrimental effect by amplifying cardiovascular events.
  • An increased systemic vascular resistance and cardiac left ventricular hypertrophy resulted from a 60-week e-cigarette exposure period.
  • It has been demonstrated that the elements of e-cigarettes or their heat-produced byproducts impact heart function.


Since nicotine, an alkaloid from the tobacco plant has received the most attention among the biologically active chemicals found in e-cigarettes, many of the cardiovascular effects of e-cigarettes have been linked to it. The frequency and intensity of smoking traditional cigarettes have been linked to higher nicotine levels in e-cigarettes. For instance, although the nicotine in e-cigarettes can temporarily raise blood pressure, most epidemiological studies have not found a connection between continuous smoking and elevated blood pressure. The effects of nicotine on systemic hemodynamics are regulated via the sympathetic nervous system’s activation. Therefore, acute nicotine administration causes systemic vasoconstriction and raises the heart rate, stimulating cardiac function.

Key Takeaway

Studies contrasting the impact of e-cigarettes on CVD vs. the consequences of e-cigarettes on CVD have been well established during the last few years. The molecular mechanism of e-cigarette impacts on the cardiovascular system is unquestionably emerging, even though it is still debatable whether switching to e-cigarettes will reduce the harm caused by conventional cigarettes. Common diseases that affect the general population share similar mechanisms with the effects of e-cigarettes on CVD. 

A specific e-cigarette must be compared to traditional cigarettes to be designed as being safer than those smokes. Since e-cigarette hardware and liquids are constantly evolving, today’s safety data might not be relevant in a few years. With e-cigarettes, the scientific debate that began years before over smoking and health is certain to persist.

Journal Reference

Espinoza-Derout, J., Shao, X. M., Lao, C. J., Hasan, K. M., Rivera, J. C., Jordan, M. C., Echeverria, V., Roos, K. P., Sinha-Hikim, A. P., & Friedman, T. C. (2022). Electronic cigarette use and the risk of cardiovascular diseases. Frontiers in Cardiovascular Medicine, 9. 

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