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Current 22 - Update on E-Cigarettes and Cardiovascular Disease Risk



Electronic cigarettes (e-cigarettes) are popular recreational substances with uncertain long-term health effects. A recent longitudinal study in Circulation compared cardiovascular disease (CVD) risk in exclusive smokers, exclusive e-cigarette users, dual users of e-cigarettes and cigarettes, and nonusers. Exclusive e-cigarette use was not associated with increased risk of CVD compared to nonsmokers and was associated with a 30-40% lower risk of CVD compared to exclusive smokers. Dual users and exclusive smokers had no difference in CVD risk.

The study analyzed self-reported data from a national cohort of 24,027 adults in the PATH (Population Assessment of Tobacco and Health) study from 2013-2019.1  Incident CVD was defined as any CVD diagnosis of bypass surgery or myocardial infarction (MI), heart failure (HF), stroke, or other heart condition. A separate outcome included only MI, HF, or stroke.

Key study limitations include a short follow-up duration, the small sample size in e-cigarette user groups, self-reported results, non-adjudicated endpoints, loss of 18% of participants to follow-up, and the inclusion of former smokers in the nonsmoker reference group. Larger, more definitive longitudinal studies are needed.

Although accumulating evidence suggests users of e-cigarettes alone may be at lower risk for cardiovascular events than cigarette smokers, discontinuing the use of e-cigarettes and tobacco products is recommended to reduce CVD risk.


  1. Berkowitz JB, Xie W, Harlow AF, et al. E-Cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study (2013-2019). Circulation. 2022;145(20):1557-1559. doi:10.1161/CIRCULATIONAHA.121.057369.


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