Risk Modulation by Electronic Cigarette Consumption in Cardiovascular Disease and Its Relevance in Cardiac Surgery—A Narrative Review

The detrimental effect of cigarette smoking has become undeniable, based on decades of research. Twenty years ago, the electronic cigarette was introduced to the market and has since then been presented as the alleged healthy alternative. Clever marketing by the industry has led to a global rise in the number of users, especially adolescents and young adults. Clinicians and scholars have praised the electronic cigarette as a tool for tobacco smoke cessation, hoping for a reduction in burden on healthcare systems. Yet accumulating evidence suggests otherwise. Over the years, several in vitro and in vivo studies in animal models and humans have shown electronic cigarettes to be associated with pulmonary, cancerous and cardiovascular diseases. This review revisits the so-far available clinical evidence concerning cardiovascular diseases and discusses research gaps that still need to be addressed, specifically focusing on patients undergoing cardiac surgery.