New Study Links E-Cigarette Use to Increased Risk of COPD and Hypertension
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A large-scale study led by Johns Hopkins Medicine has revealed that exclusive use of e-cigarettes is significantly associated with an increased risk of chronic obstructive pulmonary disease (COPD), and may also be linked to a slight rise in high blood pressure among adults aged 30 to 70. The analysis, published in Nicotine & Tobacco Research used medical data from nearly 250,000 individuals over four years, providing one of the most comprehensive examinations to date of vaping’s long-term health impacts.
The study analyzed health outcomes across several tobacco use groups: exclusive e-cigarette users, exclusive combustible cigarette users, dual users, and non-users. Of the 249,190 participants, 3,164 were exclusive e-cigarette users, while over 33,000 used only combustible cigarettes. During the follow-up period, researchers documented over 23,000 new cases of hypertension, more than 13,000 new cases of type 2 diabetes, and nearly 8,000 new cases of COPD. Exclusive e-cigarette use was found to be significantly associated with the development of COPD, and in a specific sub-group aged 30–70, with a slight increase in hypertension risk. However, it was not significantly linked to heart failure, atherosclerotic cardiovascular disease, or type 2 diabetes.
In contrast, exclusive use of traditional cigarettes was strongly associated with higher risk across all measured outcomes, including heart failure and cardiovascular disease. Dual users—those who smoked both e-cigarettes and combustible cigarettes—had slightly higher risk levels than exclusive smokers, further emphasizing the dangers of continued traditional cigarette use.
Dr. Michael Blaha, senior author of the study and professor of cardiology and epidemiology at the Johns Hopkins University School of Medicine, highlighted the importance of the findings in shaping public understanding and policy. “There remains great uncertainty about the relative harm of e-cigarettes as compared to traditional smoking. Until now, there has been scant longitudinal data in large high-quality datasets linking exclusive e-cigarettes use to new-onset cardiometabolic health conditions,” he said. “This study suggests that e-cigarettes have definite potential health risks, although the risks may be less than what is seen for traditional combustible cigarette smoking alone.”
The researchers noted that while e-cigarettes are often marketed as a safer alternative to smoking, their aerosols can contain dangerous organic compounds and high levels of nicotine, posing risks especially for younger users.
Reference: John Erhabor, Zhiqi Yao, Erfan Tasdighi, Emelia J Benjamin, Aruni Bhatnagar, Michael J Blaha, E-cigarette Use and Incident Cardiometabolic Conditions in the All of Us Research Program, Nicotine & Tobacco Research, 2025;, ntaf067, https://doi.org/10.1093/ntr/ntaf067
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