Cardiovascular health effects of vaping e-cigarettes: a systematic review and meta-analysis
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Accepted Version
Date
2025-01-24
Authors
Kundu, Anasua
Feore, Anna
Sanchez, Sherald
Abu- Zarour, Nada
Sutton, Megan
Sachdeva, Kyran
Seth, Siddharth
Schwartz, Robert
Chaiton, Michael
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Publisher
BMJ Publishing Group
Published Version
Abstract
Background There is substantial interest in the cardiovascular effects of e-cigarette use, highlighting the need to update our knowledge on the subject. We conducted this review to analyse whether e-cigarette use increases cardiovascular health risks and how these risks vary among different populations. Methods We searched six databases and included peer- reviewed human, animal, cell/in vitro original studies but excluded qualitative studies, which were published between July 2021 and December 2023. Three types of e-cigarette exposure were examined: acute, short-to-medium term and long term. Different risk of bias tools were used for assessing the quality of the included human studies and we conducted meta- analysis when possible. Results We included 63 studies in the main analysis, 12 studies in the meta-analysis and 32 studies in the sociodemographic factor- based subgroup analysis. Over half of the human studies had low risk of bias. Acute exposure to e-cigarette was associated with increased heart rate (HR) (mean difference (MD) 11.329, p<0.01) and blood pressure (BP) (MD 12.856, p<0.01 for systolic; MD 7.676, p<0.01 for diastolic) compared with non- use. While HR was lower after acute exposure to e- cigarettes compared with cigarettes (MD −5.415, p<0.01), no significant difference in systolic or diastolic BP was observed. Non- smoker current vapers had no significant differences in resting HR and BP compared with non- users but lower resting HR (MD −2.608, p<0.01) and diastolic BP (MD −3.226, p<0.01) compared with non-vaper current smokers. Despite some association between e- cigarette and endothelial dysfunction, short- to- medium- term transition from cigarettes to e-cigarettes may improve blood flow and BP, particularly among females and younger individuals. There is lack of evidence supporting any association of e-cigarette use with cardiovascular diseases and cardiac dysfunction or remodelling. Conclusions This review highlighted several important cardiovascular impacts of e-cigarette use compared with non-use and cigarette smoking. However, the evidence is still limited and requires future research.
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Keywords
Cardiovascular health effects , Vaping e-cigarettes , E-cigarette exposure
Citation
Kundu, A., Feore, A., Sanchez, S., Abu-Zarour, N., Sutton, M., Sachdeva, K., Seth, S., Schwartz, R. and Chaiton, M. (2025) ‘Cardiovascular health effects of vaping e-cigarettes: a systematic review and meta-analysis’, Heart, 325030 (10pp). https://doi.org/10.1136/heartjnl-2024-325030
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© 2025, the Authors (or their employer(s)). No commercial re- use.