Switching to vaping raises heart risk, warns ICMR; quitting fully only way

Pooling data from global studies, the ICMR research shows vaping increases cardiovascular risk, with the sharpest rise seen among smokers who switched to e-cigarettes

Switching from cigarettes to vapes or e-cigarettes may not protect the heart as many smokers believe. A new study led by the Indian Council of Medical Research (ICMR) has found that people who use e-cigarettes face a significantly higher risk of heart attack and stroke compared to non-users, with the risk rising sharply among former smokers who turn to vaping.

 

The findings come from a large systematic review and meta-analysis titled “Are electronic cigarettes associated with the risk of myocardial infarction and stroke?”, published in the journal BMC Public Health. The study analysed data from multiple international studies to assess the cardiovascular impact of e-cigarette use.

 

What did the ICMR study find?

 

The researchers examined data from 12 observational studies, covering over 1.2 million participants. Their analysis showed:

 

• E-cigarette users had a 53 per cent higher risk of myocardial infarction (heart attack) compared to people who did not use e-cigarettes
• Former smokers who switched to e-cigarettes had a 2.5-times higher risk of heart attack  and 1.73 times higher risk of stroke compared to non-users

The association held even after adjusting for conventional smoking, with e-cigarette users facing a 1.24-times higher heart attack risk. 

The authors noted that while exclusive e-cigarette use among people who never smoked showed less consistent results, the risks became clear when vaping followed years of cigarette smoking.

 

Why switching to vaping may not be safer?

 

E-cigarettes are often marketed as a “harm-reduction” tool for smokers trying to quit. However, the study highlights that nicotine exposure itself remains harmful, regardless of the delivery method.

 

According to the researchers, e-cigarette aerosols can increase

• oxidative stress
• inflammation
• endothelial dysfunction
• platelet activation

 

All of the above are known contributors to heart attacks and strokes.

Heating agents used in vapes, such as propylene glycol, can also produce toxic by-products that damage blood vessels over time.

Nicotine in any form is detrimental to cardiovascular health, cautions the study, adding that comparing e-cigarettes only with conventional cigarettes, rather than with complete abstinence, can give a false sense of safety.

 

What this means for smokers

 

“This research shatters the myth that e-cigarettes are harmless alternatives to conventional smoking,” said Dr Shalini Singh, Director of the ICMR–National Institute of Cancer Prevention and Research (NICPR) and senior author of the study.

 

The study’s lead author, Dr Ruchika Gupta, Scientist at the ICMR–National Institute of Cancer Prevention and Research (NICPR), said nicotine sets off a cascade of harmful effects in the body.

“It increases heart rate and blood pressure, damages the protective lining of blood vessels, promotes blood clot formation and accelerates the buildup of plaque in arteries. These effects occur whether nicotine comes from a conventional cigarette or an e-cigarette,” she said.

 

She added that a large proportion of young heart attack patients in India are smokers, underscoring how early and sustained nicotine exposure is reshaping cardiovascular risk.

 

ICMR researchers emphasise that e-cigarettes should not be promoted as a safe alternative, especially in countries like India, where non-smokers and young people are increasingly being exposed to vaping products.

 

The evidence supports the government’s e-cigarette ban, introduced to address potential health risks. 

 

How does the study back India’s e-cigarette ban?

 

India moved early to restrict vaping. In September 2019, the government enforced the Prohibition of Electronic Cigarettes Act, 2019, which was later approved by Parliament. The law prohibits the manufacture, production, import, export, transport, sale, distribution, storage and advertisement of e-cigarettes and related devices across the country. Possession and storage are also banned, with penalties including fines and imprisonment.

 

The decision was driven by concerns over rising e-cigarette use among young people and the absence of robust evidence that vaping is a safe alternative to smoking. The ban aligns with India’s broader tobacco-control strategy and commitments under the WHO Framework Convention on Tobacco Control.

 

However, illicit sales continue both online and offline, raising questions about regulatory gaps and the continued exposure of users to potential health risks despite the ban.

 

Limits and next steps

 

The authors acknowledge that most studies included were cross-sectional, meaning they cannot prove direct causation. However, the consistency of results, especially among former smokers, strengthens concerns about vaping’s cardiovascular effects.

 

They call for long-term, well-designed studies to better understand how duration and frequency of e-cigarette use influence heart and brain health.

 

For now, the study delivers a strong warning that vaping is not risk-free and quitting nicotine altogether remains the healthiest choice. 

Also read: Why we keep smoking despite knowing the damage it does to our health

 

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This report is for informational purposes only and is not a substitute for professional medical advice.