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E-cigarettes linked to increased risk of heart failure

According to a recent prospective study led by MedStar Health in Baltimore, users of e-cigarettes face a significantly increased risk of developing heart failure compared to those who have never used them.

Affecting over six million adults in the U.S., heart failure is a condition characterized by the heart’s inability to pump blood effectively due to it being either too stiff or too weak. This can lead to severe symptoms and frequent hospitalizations as individuals age. 

E-cigarettes and heart health 

Electronic nicotine delivery systems, encompassing e-cigarettes, vape pens, hookah pens, personal vaporizers, mods, e-cigars, e-pipes, and e-hookahs, emit nicotine in an aerosol form without burning tobacco. 

Despite their introduction in the U.S. in the late 2000s and initial claims of being a safer smoking alternative, a growing body of evidence raises concerns about their health implications.

“More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought,” said lead author Yakubu Bene-Alhasan, a resident physician at MedStar. “The difference we saw was substantial. It’s worth considering the consequences to your health, especially with regard to heart health.”

E-cigarette use and heart failure 

This investigation utilized data from the All of Us Research Program, a large national study led by the National Institutes of Health, focusing on the correlation between e-cigarette usage and new diagnoses of heart failure among 175,667 participants. 

The group, including 60.5% females with an average age of 52, saw 3,242 individuals develop heart failure over a median follow-up period of 45 months.

The analysis revealed that individuals with any history of e-cigarette use had a 19% higher chance of experiencing heart failure compared to non-users. 

Other risk factors for heart disease 

This assessment took into account various factors including demographic and socioeconomic backgrounds, other risk factors for heart disease, and the use of substances such as alcohol and tobacco. According to the scientists, the age, sex, or smoking status of participants did not alter the impact of e-cigarettes on heart failure risk.

Diving deeper, the risk increase was statistically significant for heart failure with preserved ejection fraction (HFpEF) – a condition where the heart muscle does not relax as it should. 

However, this link was not found for heart failure with reduced ejection fraction (HFrEF), which involves a weakened heart muscle. With rising HFpEF rates, identifying risk factors and enhancing treatments has become a priority.

Further research is urgently needed 

The study aligns with animal research and other human studies suggesting that e-cigarette use could negatively affect the heart in ways that contribute to heart failure. Past attempts to directly connect e-cigarette use with heart failure have faced challenges due to the limitations of cross-sectional study designs, small sample sizes, and fewer heart failure cases.

“I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” said Bene-Alhasan. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done.” 

“With more research, we will get to uncover a lot more about the potential health consequences and improve the information out to the public.”

The relationship between e-cigarettes and heart failure 

Bene-Alhasan also cautioned against using e-cigarettes as a cessation too since many people may continue vaping long after they quit smoking. Instead, the U.S. Centers for Disease Control and Prevention (CDC) advocates for a mix of counseling and medication as the most effective quitting approach.

Although the study’s design allows for inferences rather than definitive conclusions about the causal relationship between e-cigarette use and heart failure, its extensive sample size and detailed substance use and health information render it a critical step forward in understanding this relationship.

More about e-cigarettes 

E-cigarettes, also known as electronic cigarettes, are devices designed to simulate the experience of smoking without burning tobacco. 

They work by heating a liquid to generate an aerosol, commonly referred to as vapor, that the user inhales. This liquid typically contains nicotine (the addictive substance found in traditional cigarettes), flavorings, and other chemicals. 

E-cigarettes were initially introduced as a tool to help smokers reduce or quit their cigarette smoking.

Ongoing debate

The use of e-cigarettes has sparked a considerable amount of debate among health professionals, regulatory agencies, and the public. 

Supporters argue that e-cigarettes are a safer alternative to traditional cigarettes because they do not produce tar or carbon monoxide, two of the most harmful components in tobacco smoke. They also point to the potential benefits for smokers who have struggled to quit smoking by other means.


However, e-cigarettes are not without their controversies. Critics raise concerns about the health risks associated with inhaling the chemicals found in the vapor, including the potential for lung injury. 

There is also worry about the appeal of flavored e-cigarettes to teenagers and young adults, potentially leading them to start using nicotine, a highly addictive substance. This has led to discussions about the regulation of flavors and marketing practices that may target younger individuals.


The regulatory landscape for e-cigarettes varies widely from country to country, ranging from complete bans to relatively loose regulations. Many countries are still evaluating how to regulate these products, balancing the potential benefits for smokers looking to quit with the risks of increasing nicotine addiction among non-smokers, particularly youth.

The study will be presented at the American College of Cardiology’s Annual Scientific Session.


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