A recent meta-analysis published in BMC Public Health has found that the use of electronic cigarettes is linked to a higher risk of heart attack, especially among people who previously smoked traditional cigarettes. The study reviewed data from 12 observational studies, involving over 430,000 participants for heart attack analysis and more than 1.1 million for stroke analysis.
Researchers reported that e-cigarette users had a 53% higher chance of experiencing a myocardial infarction compared to non-users. The risk was even greater among former smokers who now use e-cigarettes, with odds more than double those of non-users. "Former cigarette smokers who currently use e-cigarettes had a 2.52-fold higher odds of MI compared with non-users (OR 2.52, 95% CI 1.88–3.16). The authors note that this may reflect residual confounding or cumulative effects of prior smoking rather than a direct causal effect of vaping alone."
The study also examined the risk of stroke and found no significant increase overall among e-cigarette users after adjusting for smoking history. However, former smokers using e-cigarettes faced a significantly higher risk—73% above non-users.
For individuals who have never smoked traditional cigarettes but use e-cigarettes exclusively, the analysis did not find a statistically significant link to increased heart attack or stroke risk.
The researchers highlighted several limitations in their findings, including the cross-sectional nature of most included studies and potential biases related to participant selection and reporting. They emphasized the need for further high-quality longitudinal research to clarify these associations.
"These findings raise concerns about the cardiovascular safety of e-cigarettes and indicate that they should not be assumed to be risk-free alternatives," according to the authors.
The review excluded studies with financial ties to the tobacco industry in an effort to reduce bias in its conclusions.
The authors concluded: "This systematic review suggests that e-cigarette use is associated with increased odds of myocardial infarction, particularly among individuals with a history of cigarette smoking... further high-quality longitudinal studies are required and that e-cigarettes should not be considered harmless from a cardiovascular perspective."
