Vaping is not harmless for the heart, but its long-term effect on heart attack and stroke is not yet known. E-cigarettes cause measurable short-term changes in heart rate and blood pressure. What is missing is decades of follow-up of the kind that exists for cigarettes.
For someone who smokes, switching completely appears to improve some measures of blood vessel health in the short term. For someone who has never smoked, vaping adds an exposure with no health benefit.
Key takeaways
- E-cigarettes raise heart rate and blood pressure slightly right after use.
- No study has yet followed vapers long enough to show what vaping does to heart attack and stroke rates.
- Using both cigarettes and e-cigarettes is linked with worse outcomes than smoking alone.
- Expert bodies disagree on vaping as a way to quit smoking, so it is a conversation to have with your clinician.
What vaping does in the short term
An e-cigarette heats a liquid into an aerosol that you inhale. Most liquids contain nicotine, which stimulates the heart and narrows blood vessels.
A pooled analysis of 14 studies with 441 participants measured the immediate effects. Right after e-cigarette use, heart rate rose by about 2 beats per minute, and systolic and diastolic blood pressure each rose by about 2 mmHg. The authors concluded that, unless stronger evidence supports it, the e-cigarette should not be labelled a cardiovascular safe product.1
The American Heart Association reached a similar view in its 2023 scientific statement. It reported that early molecular and clinical evidence suggests various acute physiological effects from e-cigarettes, particularly those containing nicotine.2
What is not known
The honest answer on long-term risk is that nobody knows yet. There are three reasons.
- Time. Heart disease takes decades to develop, and e-cigarettes have not been in wide use for long enough.
- Smoking history. Many adults who vape also smoke or used to, which makes it hard to separate the effect of vaping from the effect of cigarettes.
- Changing products. Devices, liquids and nicotine strengths vary widely and keep changing, so a study of one product may not apply to another.
Regulation adds to the gap. The American Heart Association statement points out that e-cigarettes are regulated as tobacco products, so they do not go through the premarket animal and human safety studies required of a drug or medical device. It describes more clinical research as critically needed.2
What population studies show so far
The largest summary to date pooled 107 population studies published through October 2023. It compared people who vape, people who smoke, people who do both and people who do neither.
| Comparison | Finding for cardiovascular disease |
|---|---|
| Vaping only vs. smoking only | No statistically significant difference in odds |
| Vaping and smoking vs. smoking only | Higher odds with dual use |
| Vaping only vs. using neither | Higher odds with vaping |
The first row is the one that surprises people. In this analysis, the odds of cardiovascular disease in current e-cigarette users were not statistically different from those in current smokers. The authors concluded that the assumption of substantial harm reduction across all cigarette-caused diseases needs to be reassessed.3
These findings come with a large caveat. Most of the underlying results were cross-sectional, meaning people were asked about vaping and disease at a single point in time. That design cannot show which came first, and many vapers are former smokers whose disease may trace back to cigarettes.
Vaping compared with smoking
One randomized trial looked at what happens inside the blood vessels when smokers switch. It enrolled adults who had smoked at least 15 cigarettes a day for two years or more. Within one month of switching to e-cigarettes, the function of the blood vessel lining and the stiffness of the arteries both improved significantly.4
Two details matter. The people who switched most completely improved the most. And over that month there was no difference in vascular effects between e-cigarettes with nicotine and those without.
The trial lasted one month and measured vessel function, not heart attacks. It supports the idea that a full switch is easier on the blood vessels than continued smoking in the short term. It cannot say whether that advantage lasts.
Why dual use is the worst of both
Many people who take up vaping keep smoking as well. The evidence on this pattern is more consistent than on vaping alone.
In the pooled analysis, people who both smoked and vaped had higher odds of every disease outcome studied than people who only smoked.3 Adding e-cigarettes on top of cigarettes does not reduce harm. If any benefit exists, it appears to depend on stopping cigarettes completely.
Vaping as a way to quit smoking
This is where expert bodies part ways, and it is worth seeing both positions.
A 2025 Cochrane review concluded there is high-certainty evidence that nicotine e-cigarettes increase quit rates compared with nicotine replacement therapy. In absolute terms it estimated about four more people quitting per 100. The reviewers found no evidence of serious harm, but said longer and larger studies are needed to fully evaluate safety.5
The US Preventive Services Task Force took a more cautious line in 2021. It judged the evidence on e-cigarettes for quitting to be insufficient, and recommended that clinicians direct people who use tobacco to cessation methods with proven effectiveness and established safety.6
We do not make a recommendation here. If you smoke and are thinking about how to stop, talk it through with your clinician. Our guide to heart risk after quitting smoking covers how risk changes once you do.
Your next step
Whether you vape, smoke or have done either in the past, tobacco history is one input into your heart risk, and it sits alongside blood pressure, cholesterol and blood sugar. Our guide to a heart disease risk assessment explains how those pieces are put together, and the PREVENT calculator guide shows how smoking status feeds into a risk estimate.
You can also answer the three quick questions in the screener on the Cardio Res-Q program page. Tobacco history is on the list of risk factors the program screens for.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
Is vaping better for your heart than smoking?
Possibly in the short term, if you switch completely, but it is not proven for the long term. One trial found better blood vessel function a month after smokers switched. A large pooled analysis of population studies found no clear difference in cardiovascular disease between vapers and smokers. Neither settles the question.
Can vaping cause a heart attack?
It is not known. Vaping raises heart rate and blood pressure slightly right after use, and population studies link it with more cardiovascular disease than using nothing. Long-term studies that could show whether vaping leads to heart attacks have not been done yet.
Is nicotine-free vaping safe for the heart?
There is too little evidence to say. The American Heart Association notes that acute effects are seen particularly with nicotine-containing products. In one month-long trial, though, vessel effects did not differ between e-cigarettes with and without nicotine. Nicotine-free does not mean tested and safe.
I vape and smoke. Is cutting down on cigarettes enough?
The evidence suggests not. People who both smoke and vape had higher odds of disease than people who only smoke in the largest pooled analysis. Talk to your clinician about a plan to stop cigarettes completely.
Related reading
This article is for general education and is not medical advice. Decisions about testing and medication should be made with your clinician. If you have chest pain or other symptoms of a heart attack, call 911.
