E-cigarette use has surged in popularity over the past decade, especially among youth and young adults, often marketed as a safer alternative to traditional smoking1 . However, emerging evidence shows that people who have used e-cigarettes at any point in their lives are about 19% more likely to develop heart failure compared with those who have never vaped2 . This increased risk is particularly significant for heart failure with preserved ejection fraction, a condition where the heart muscle becomes stiff and does not fill properly between beats3 . Understanding the cardiovascular risks associated with vaping is critical as its use continues to grow4 .
“These results are a critical stepping stone for future prospective research on the health effects of e-cigarettes.”
— Michael Blaha, M.D., M.P.H., Johns Hopkins University School of Medicine12
Key Study Findings on E-Cigarettes and Heart Health
Current high-quality research specifically linking e-cigarette use to incident heart failure is limited, with most large studies focusing on other cardiovascular outcomes such as myocardial infarction, arrhythmias, or vascular dysfunction5 6. A 2023 systematic review reported a modest increase in the incidence and mortality of cardiovascular diseases—including heart failure—among e-cigarette users, but noted that the underlying biological mechanisms remain unclear5 . One U.S. population study found that 1.7% of e-cigarette users reported a history of congestive heart failure, though this study did not establish causality or adjust for confounding factors6 .
More recent analyses have strengthened the association between e-cigarette use and heart failure risk. People who used e-cigarettes at any point were 19% more likely to develop heart failure than never-users2 3. This increased risk was statistically significant for heart failure with preserved ejection fraction (HFpEF), where the heart muscle becomes stiff and does not fill properly, but not for heart failure with reduced ejection fraction (HFrEF), characterized by weakened heart muscle and poor contraction2 3. Furthermore, dual users of both combustible cigarettes and e-cigarettes had a 59% higher risk of heart failure compared to non-users7 .
“A lifetime of chromium and nickel exposure as a result of daily inhalation of 2 mL e-liquid was used to estimate the risk of cancer and noncancer health effects.”
— Jason J. Rose, University of Maryland School of Medicine1
Additional cardiovascular risks linked to e-cigarette use include higher rates of coronary heart disease, arrhythmias, and chest pain8 . People who vape also show worse performance on treadmill exercise tests that predict heart disease risk, with cardiovascular function impairments similar to those seen in combustible cigarette smokers, despite being younger and having shorter exposure durations9 .
Experts emphasize the growing evidence of harm from e-cigarettes. Dr. Yakubu Bene-Alhasan notes, “More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought” 2. Dr. Cheng-Han Chen adds, “We know in other studies that nicotine itself has deleterious effects on the heart” 3.
- E-cigarette users have a 19% increased risk of developing heart failure compared to never-users2 3.
- The risk is significant for heart failure with preserved ejection fraction (HFpEF) but not for reduced ejection fraction (HFrEF) 23.
- Dual use of combustible cigarettes and e-cigarettes raises heart failure risk by 59% 7.
- E-cigarette use is associated with higher rates of coronary heart disease, arrhythmias, and chest pain8 .
- Vapers perform worse on cardiovascular exercise tests, similar to smokers9 .
💡 Did You Know? People who use e-cigarettes are significantly more likely to develop heart failure compared with those who have never used them. Heart failure affects more than 6 million adults in the U.S. 2
How Vaping May Damage Cardiovascular Function
The exact biological mechanisms by which e-cigarettes may contribute to heart failure and other cardiovascular diseases are not fully understood, but several pathways have been proposed based on preclinical and clinical evidence5 10. Chronic exposure to e-cigarette aerosols has been shown in animal studies to increase arterial stiffness and impair vascular function, both of which are risk factors for heart failure11 . Human studies also indicate that e-cigarette use can cause acute increases in heart rate and blood pressure, putting the cardiovascular system into a state of sympathetic nervous system activation, often described as “fight or flight” 4.
Nicotine, a primary component in most e-cigarettes, stimulates the release of catecholamines (stress hormones) that activate β-adrenergic receptors in the heart. This leads to increased heart rate, cardiac contractility, and workload. Over time, chronic overstimulation of the sympathetic nervous system can cause cardiac remodeling, promoting heart failure development and increasing the risk of arrhythmias1 . Additionally, e-cigarette use has been linked to reduced production of nitric oxide by blood vessel cells—up to 30% less—which is essential for relaxing vessels and maintaining healthy blood flow4 .
“The difficulty is that every vaping product is different, so it is harder to identify and link the disorders to which they are contributing.”
— Geoffrey Williams, M.D., Ph.D., University of Michigan Health Frankel Cardiovascular Center4
Other harmful substances found in e-cigarette aerosols include metals such as nickel and chromium, which are present at higher levels than in combustible cigarettes. Lifetime exposure to these metals through daily vaping may increase the risk of cancer and non-cancer health effects, including cardiovascular damage1 . E-cigarettes also contribute to inflammation and elevated blood lipid levels, which promote atherosclerosis—a major risk factor for heart failure and other cardiovascular diseases3 .
People who vape experience immediate adverse cardiovascular effects similar to those who smoke combustible cigarettes. Both groups show increased blood pressure, heart rate, and blood vessel constriction shortly after use. These acute changes, combined with chronic vascular damage, may explain the increased cardiovascular risk observed in e-cigarette users9 .
- Nicotine-induced sympathetic nervous system activation increases heart rate and cardiac workload4 1.
- Chronic sympathetic overstimulation leads to cardiac remodeling and arrhythmias1 .
- Reduced nitric oxide production impairs blood vessel relaxation and blood flow4 .
- Exposure to metals like nickel and chromium may cause vascular and systemic toxicity1 .
- E-cigarettes promote inflammation and elevated blood lipids, contributing to atherosclerosis3 .
- Acute increases in blood pressure and heart rate occur immediately after vaping9 .
- Animal studies show increased arterial stiffness and vascular dysfunction after chronic exposure11 .
