New study reveals E-cigarette use poses elevated risk of heart failure

According to the study, E-cigarette use was associated with increased risk for incident heart failure compared with never use. The association was significant even after adjustment for concomitant substance use and other risk factors.

Heart failure is a condition that affects more than 6 million US adults in which the heart becomes too stiff or too weak to pump blood as effectively as it should. It can often lead to debilitating symptoms and frequent hospitalizations as people age. Electronic nicotine products, which include vape pens, e-cigarettes, personal vaporizers and mods, hookah pens, e-cigars, e-pipes, and e-hookahs, deliver nicotine in aerosol form without combustion.

Since their first introduction in the US in the late 2000s, electronic nicotine products have often been portrayed as a safer alternative to smoking, but a growing body of research has suggested increased concern about potential adverse health effects.

Surveys indicate that about 5% to 10% of US teens and adults use e-cigarettes. In 2018, the US Surgeon General called youth e-cigarette use an epidemic and warned about the health risks associated with nicotine addiction.

“More and more studies are linking e-cigarettes to harmful effects and finding that it might not be as safe as previously thought,” Yakubu Bene-Alhasan, a resident physician at MedStar Health in Baltimore and the study’s lead author, said in a press release.

“The difference we saw was substantial. It’s worth considering the consequences to your health, especially about heart health.”

For the study, the researchers aimed to analyze associations between e-cigarette use and new diagnoses of heart failure in 175,667 study participants (an average age of 52 years and 60.5% female). For this purpose, they used data from surveys and electronic health records in All of Us, a large national study of US adults run by the National Institutes of Health.

Following were the study’s key findings:

• Of this sample, 3,242 participants developed heart failure within a median follow-up time of 45 months.
• People who used e-cigarettes at any point were 19% more likely to develop heart failure compared with people who had never used e-cigarettes. In calculating this difference, a variety of demographic and socioeconomic factors, other heart disease risk factors, and participants’ past and current use of substances, including alcohol and tobacco products, were accounted for.
• There was no evidence that participants’ age, sex, or smoking status modified the relationship between e-cigarettes and heart failure.
• The increased risk associated with e-cigarette use was statistically significant for heart failure with preserved ejection fraction (HFpEF)—in which the heart muscle becomes stiff and does not fill with blood between contractions. However, this association was not significant for heart failure with reduced ejection fraction (HFrEF)—in which the heart muscle becomes weak, and the left ventricle does not squeeze as hard as it should during contractions.

The findings align with previous studies conducted in animals, which signaled e-cigarette use can affect the heart in ways that are relevant to the heart changes involved in heart failure.

Other studies in humans have also shown links between e-cigarette use and some risk factors associated with developing heart failure. However, previous studies attempting to assess the direct connection between e-cigarette use and heart failure have been inconclusive, which Bene-Alhasan said is due to the inherent limitations of smaller sample sizes, cross-sectional study designs, and the smaller number of heart failure events seen in previous research.

Researchers said the new study findings point to a need for additional investigations of the potential impacts of vaping on heart health, especially considering the prevalence of e-cigarette use among younger people.

“I think this research is long overdue, especially considering how much e-cigarettes have gained traction,” Bene-Alhasan said. “We don’t want to wait too long to find out eventually that it might be harmful, and by that time a lot of harm might already have been done. With more research, we will get to uncover a lot more about the potential health consequences and improve the information to the public.”

Bene-Alhasan also said e-cigarettes are not recommended as a tool to quit smoking since many people may continue vaping long after they quit smoking. The U.S. Centers for Disease Control and Prevention recommends a combination of counseling and medications as the best strategy for quitting smoking.