Cardiovascular Risks of Electronic Cigarettes: Mechanisms, Evidence, and Research Gaps

Introduction: Electronic cigarettes (ECs), or electronic nicotine delivery systems (ENDS), are increasingly promoted as safer alternatives to conventional cigarettes, especially among younger populations. However, concerns remain regarding their cardiovascular effects. Methods: This review synthesized evidence from PubMed, Embase, and Web of Science databases to examine the association between e-cigarette use and cardiovascular health. Eligible sources included observational studies, experimental research, and systematic reviews evaluating exposure to nicotine and other harmful compounds present in e-cigarettes. Results: Evidence indicates that e-cigarette use exposes individuals to harmful chemicals such as nicotine and carbonyl compounds, which are linked to endothelial dysfunction, arrhythmias, coronary artery disease, and progression of atherosclerosis. While some studies suggest reduced exposure to ecigarettes compared with conventional smoking, measurable adverse cardiovascular outcomes remain significant. Discussion: The findings suggest that although e-cigarettes may serve a role in harm reduction and smoking cessation, their potential to induce cardiovascular risk cannot be overlooked. Current evidence highlights both short-term vascular changes and possible long-term health consequences, though robust longitudinal data remain limited. Conclusion: E-cigarette use is associated with cardiovascular risks despite being marketed as a safer alternative to traditional smoking. There is an urgent need for comprehensive, long-term studies and public health initiatives to clarify these risks and guide appropriate regulatory policies.