Study: E-Cigarette Use Associated with Higher Risk of Heart Failure

Fact checked by Nick Blackmer

• Vaping could impact the heart in similar ways to smoking tobacco.

• Nicotine causes arteries to stiffen and blood pressure to rise, both of which put strain on the cardiovascular system.

• Doctors are still trying to understand how vaping impacts heart health, and it will likely be decades before we have a clear picture.

A new study suggests that people who’ve used electronic cigarettes at some point in their lives have a higher chance of developing heart failure compared to those who’ve never vaped.

Electronic cigarettes, or e-cigarettes, are battery-operated devices that work by heating a liquid that usually contains nicotine into an aerosol that’s inhaled. The devices entered the scene in the early 2000s as a safer alternative to smoking cigarettes. Yet, a growing body of research suggests they also pose health risks.

“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, MD, MPH, a resident physician at MedStar Health in Baltimore, in a statement. “The difference we saw was substantial. It’s worth considering the consequences to your health, especially with regard to heart health.”

Heart failure doesn’t mean the heart stops working, as its name suggests. Instead, it's a serious but sometimes manageable condition that occurs when a person’s heart can’t pump enough blood and oxygen to other organs in the body. About 6.2 million people in the United States have heart failure.

While scientists know that smoking tobacco is one of the most significant lifestyle contributors to heart failure, they’re still exploring how e-cigarettes might influence the condition.

The new study, presented the American College of Cardiology's Annual Scientific Session and published in the Journal of the American College of Cardiology, did not show that using e-cigarettes triggers heart failure, Bene-Alhasan told Health. But he said “there are reasons” for researchers to believe it does.

Here’s what you need to know about the connection between e-cigarettes and heart failure, including what could account for the device’s impact on the heart.

A Closer Look at the Study’s Findings

The study included nearly 176,000 participants with an average age of 52. About 70% were White, 20% were Black, and 10% were Asian or Hispanic.

Researchers used data from electronic health records as well as participant surveys to determine whether people vaped, used tobacco in any form, or drank alcohol. The reports also showed whether participants had ever vaped in the past.

The team followed up with participants for about four years. During that time, a total of 3,242 people had developed heart failure.

After crunching the numbers, researchers found that people who’d used e-cigarettes were 19% more likely than non-vapers to have a type of heart failure in which the heart muscle becomes stiff and doesn’t fill with blood as it should. Vaping didn’t appear to be linked to another kind of heart failure caused by a weakened heart.

As part of their analysis, the team adjusted for other key heart failure risk factors, including diabetes, high blood pressure, hyperlipidemia, and a high body mass index.

Because the study was observational, it suggests only an association between vaping and heart failure and not that e-cigarettes cause the condition.

“This adds to the list of potential conditions that are linked with vaping,” Bene-Alhasan said.

However, Holly Middlekauff, MD, a professor of medicine and physiology at UCLA’s David Geffen School of Medicine, told Health that the study was limited by researchers not knowing whether a person had ever smoked tobacco in the past. Because many people, especially older adults, use e-cigarettes to replace smoking, the supposed link between heart failure and e-cigarette use may, in reality, be an association between tobacco use and heart failure, she explained.

However, it’s “unlikely that electronic cigarettes are harmless,” she added. “If you don’t smoke tobacco cigarettes, you shouldn’t start smoking electronic cigarettes.”

For people who already smoke tobacco cigarettes, though, Middlekauff said that current evidence suggests that e-cigarettes offer a safer alternative. Indeed, the study also found that people who both smoked tobacco and used e-cigarettes raised their risk of heart failure by 60%.

“I can’t think of anything else that’s legal to do that is more harmful to one’s heart than smoking tobacco cigarettes,” Middlekauff said.

Related: Just 1,000 Extra Steps a Day Can Improve Health for People With Heart Failure

Why Might Vaping Harm the Heart?

Nicotine inhalation can increase heart rate, blood pressure and flow, and the narrowing of arteries. It also may lead to the hardening of arterial walls, which can cause a heart attack.

Research on mice indicates that vaping may cause the heart to stiffen, which can lead to heart failure over time. Other mouse studies suggest e-cigarette use may lead to inflammation, which plays a well-documented role in heart disease.

Bene-Alhasan said researchers need to explore whether vaping increases inflammation in people, too, as well as how inflammation might influence the development of heart failure.

“Heart failure is now more and more being seen as an inflammatory disease,” he noted.

Bene-Alhasan said his team plans to drill into the data to assess how heart failure risk differs among age groups. They also want to better understand how having a history of tobacco use influences heart failure risk.

According to Middlekauff, it will likely be decades before scientists fully know the effect vaping might have on heart failure, especially because the condition typically develops over many years.

Bene-Alhasan stressed that what’s clear, however, is that “vaping should be discouraged while other research is being done to examine the other effects of vaping.”

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