Cardiovascular Effects and Clinical Outcomes Associated With Electronic Cigarette Use: A Narrative Review

Electronic cigarette use has increased substantially over the past decade, especially among adolescents and young adults. Although e-cigarettes are often viewed as safer than combustible cigarettes, their cardiovascular effects remain incompletely understood. This review explores the current literature on e-cigarette use and cardiovascular health, focusing on mechanisms of injury and clinical cardiovascular outcomes. E-cigarette aerosols contain nicotine, solvents, flavoring agents, carbonyl compounds, volatile organic compounds, and metals that may contribute to cardiovascular toxicity. Experimental studies show that e-cigarette exposure can cause sympathetic activation, increased heart rate and blood pressure, endothelial dysfunction, oxidative stress, inflammation, platelet activation, thrombogenesis, and increased vascular stiffness. These findings suggest several pathways by which e-cigarettes may contribute to cardiovascular disease. However, evidence linking e-cigarette use to clinical cardiovascular outcomes is less definitive. Observational studies have reported associations with myocardial infarction, stroke, and composite cardiovascular disease outcomes, but these findings are limited by cross-sectional study designs, reverse causation, and confounding by combustible cigarette use. Longitudinal studies have not consistently shown an independent association between exclusive e-cigarette use and incident cardiovascular events. Overall, e-cigarettes are not physiologically inert, but further prospective studies are needed to clarify their long-term cardiovascular risk.