Key result
E-cigarette exposure exacerbates cardiometabolic risk, with highest harm observed among dual combustible tobacco users.
Why the study?
E-cigarettes have surged in popularity as perceived safer alternatives to combustible tobacco, but evidence identifies them as independent cardiovascular and metabolic risk factors.
Does acute or chronic electronic cigarette exposure increase cardiovascular and metabolic risk factors compared to non-use or traditional combustible tobacco use?
Systematic Review
Does acute or chronic electronic cigarette exposure increase cardiovascular and metabolic risk factors compared to non-use or traditional combustible tobacco use?
E-cigarettes act as independent drivers of cardiometabolic risk, refuting their status as benign harm-reduction tools, with dual use of vaping and conventional tobacco posing the highest health risk.
E-cigarette use, especially dual use, warrants clinical avoidance for cardiometabolic risk; challenges the harm-reduction consensus and extends evidence for regulatory action.
Electronic cigarettes (e-cigarettes) have surged in global popularity as perceived safer alternatives to combustible tobacco, yet growing evidence identifies them as an independent cardiovascular and metabolic risk factor. To synthesize current knowledge, a systematic review was conducted across major databases (PubMed, Web of Science, Scopus) for high-quality studies published between 2016 and early 2026, including large-scale epidemiological data from the BRFSS and the Korean Community Health Survey. The analysis reveals that e-cigarette exposure induces acute adverse hemodynamic responses, significantly elevating blood pressure, heart rate, and cardiac workload, while chronic use leads to sustained autonomic imbalance with sympathetic predominance. At the vascular level, vaping exacerbates oxidative stress, increases arterial stiffness, and promotes a pro-inflammatory and pro-thrombotic environment. Crucially, across all cardiometabolic parameters, the most detrimental health outcomes are consistently observed among "dual users" who concurrently use both e-cigarettes and traditional combustible tobacco. Ultimately, this review refutes the narrative that e-cigarettes are a benign harm-reduction tool, concluding that they pose a significant, documented threat to cardiovascular and metabolic health. Consequently, clinical and public health prevention strategies must strongly advocate for the total cessation of all forms of nicotine delivery to protect long-term cardiovascular well-being.
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Nawrocka et al. (2026) conducted a systematic review in Cardiovascular and metabolic risk. E-cigarette exposure vs. Non-users and conventional combustible cigarette smokers was evaluated. E-cigarette exposure is an independent cardiovascular and metabolic risk factor that exacerbates hypertension, endothelial dysfunction, and dyslipidemia, with the most detrimental health outcomes consistently observed among dual users of both e-cigarettes and combustible tobacco.
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